Provider Demographics
NPI:1922263870
Name:BROUILLET, JAMES H (COTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:BROUILLET
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 LONG MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-4329
Mailing Address - Country:US
Mailing Address - Phone:203-382-4773
Mailing Address - Fax:
Practice Address - Street 1:600 N WESTSHORE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1137
Practice Address - Country:US
Practice Address - Phone:800-632-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant