Provider Demographics
NPI:1821223421
Name:PAVLUS, BRETT J (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:J
Last Name:PAVLUS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-8 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2308
Mailing Address - Country:US
Mailing Address - Phone:518-762-8215
Mailing Address - Fax:518-762-4623
Practice Address - Street 1:2-8 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2308
Practice Address - Country:US
Practice Address - Phone:518-762-8215
Practice Address - Fax:518-762-4623
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011589-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist