Provider Demographics
NPI:1144485681
Name:BRADY, LORETTA D (OTR L)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:D
Last Name:BRADY
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:ANNE
Other - Last Name:DITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5225 NESCONSET HWY
Mailing Address - Street 2:SUITE 30 NEW YORK THERAPY PLACEMENT SERVICES INC
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-473-4284
Mailing Address - Fax:631-331-2204
Practice Address - Street 1:5225 NESCONSET HWY
Practice Address - Street 2:SUITE 30 NEW YORK THERAPY PLACEMENT SERVICES INC
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-473-4284
Practice Address - Fax:631-331-2204
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist