Provider Demographics
NPI:1487052882
Name:BRILEVA, IRINA (COTA)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BRILEVA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BAY 37TH ST APT O4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6556
Mailing Address - Country:US
Mailing Address - Phone:929-400-3432
Mailing Address - Fax:
Practice Address - Street 1:275 BAY 37TH ST APT O4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6556
Practice Address - Country:US
Practice Address - Phone:929-400-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008227-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant