Provider Demographics
NPI:1831834803
Name:JUDGE, BRENDEN THOMAS (OT)
Entity type:Individual
Prefix:
First Name:BRENDEN
Middle Name:THOMAS
Last Name:JUDGE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 CAMBON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3001
Mailing Address - Country:US
Mailing Address - Phone:631-258-3913
Mailing Address - Fax:
Practice Address - Street 1:104 COMBS AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1431
Practice Address - Country:US
Practice Address - Phone:718-962-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist