Provider Demographics
NPI:1902115694
Name:HOLBROOK, DANIEL G JR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:G
Last Name:HOLBROOK
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:716 DEGRAW ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4527
Mailing Address - Country:US
Mailing Address - Phone:631-974-0500
Mailing Address - Fax:
Practice Address - Street 1:3000 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3702
Practice Address - Country:US
Practice Address - Phone:631-974-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016382225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics