NPIMap

Organization Active NPI

Bravo Occupational Therapy PC

  • Occupational Therapist
  • Hicksville, NY
National Provider Identifier
1194448449
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
BRAVO OCCUPATIONAL THERAPY PC
Practice address
111 W Old Country Rd
Hicksville, NY 11801-4036
Phone
(516) 433-4570
NPI assigned
Sep 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessenia Bravo, OTR/LNPI 1174006175
Title
Occupational Therapist
Phone
(917) 847-8697

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

111 W Old Country Rd
Hicksville, NY 11801-4036

Mailing address

104 Meister Blvd
Freeport, NY 11520-5919

Other practice location 1

104 Meister Blvd
Freeport, NY 11520-5919
Phone (917) 847-8697

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221207000658 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7517336928 Receives reassigned benefits from 1 practitioner
Practice locations: Bayside, NY; Freeport, NY; Hicksville, NY

National Provider Directory

National Provider Directory

Locations

20934 Northern Blvd
#1123
Bayside, NY 11361
Phone (516) 433-4570

111 W Old Country Rd
Unit 1
Hicksville, NY 11801
Phone (516) 433-4570

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1194448449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MEISTER BLVD",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115205919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014036",
            "telephone_number": "516-433-4570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Meister Blvd",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "NY",
            "postal_code": "115205919",
            "country_code": "US",
            "telephone_number": "917-847-8697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRAVO OCCUPATIONAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "BRAVO",
        "authorized_official_first_name": "JESSENIA",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "917-847-8697",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.