Provider Demographics
NPI:1932359403
Name:TORRALBA, MILCAH BRAVO (OT)
Entity Type:Individual
Prefix:
First Name:MILCAH
Middle Name:BRAVO
Last Name:TORRALBA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 44TH ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4653
Mailing Address - Country:US
Mailing Address - Phone:718-951-8800
Mailing Address - Fax:718-951-0846
Practice Address - Street 1:4330 44TH ST
Practice Address - Street 2:APT 3A
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-4653
Practice Address - Country:US
Practice Address - Phone:718-951-8800
Practice Address - Fax:718-951-0846
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13747225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist