Individual provider Active NPI

Susan Brabant, OTR

  • Occupational Therapist
  • North Massapequa, NY
National Provider Identifier
1720419476
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
63018509 Issued in NY
Practice address
188 North Delaware Avenue
North Massapequa, NY 11758
Phone
(516) 659-6707
NPI assigned
Dec 6, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 63018509 NY Primary
Massage Therapist 225700000X 007808 NY

Addresses

Primary practice location

188 North Delaware Avenue
North Massapequa, NY 11758

Mailing address

188 North Delaware Avenue
North Massapequa, NY 11758
Phone (516) 659-6707

Other names 1

  • Dr. Susan M Brabant Professional name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150826000211 NY Practitioner - Occupational Therapist in Private Practice 5698081396 Practice locations: N Massapequa, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007808NYMDMental Health Counselor
63018509NYMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1720419476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 NORTH DELAWARE AVENUE",
            "city": "NORTH MASSAPEQUA",
            "state": "NY",
            "postal_code": "11758",
            "telephone_number": "516-659-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 NORTH DELAWARE AVENUE",
            "city": "NORTH MASSAPEQUA",
            "state": "NY",
            "postal_code": "11758",
            "telephone_number": "516-659-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRABANT",
        "first_name": "SUSAN",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-06",
        "last_updated": "2021-03-23",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "63018509",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "007808",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "BRABANT",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "MASSAGE THERAPY",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in North Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.