Provider Demographics
NPI:1871884973
Name:BROUS, MAUREEN ELIZABETH (OTR/L)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:BROUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4304
Mailing Address - Country:US
Mailing Address - Phone:718-306-2331
Mailing Address - Fax:
Practice Address - Street 1:1770 KIMBALL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4304
Practice Address - Country:US
Practice Address - Phone:718-306-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009956OtherOT LICENSURE
NJ46TR00630400OtherSTATE OF NJ ATTORNEY GENERAL