Provider Demographics
NPI:1548848617
Name:BRUMBERG, TIARA (COTA/L)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:BRUMBERG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 CAHABA CREST DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4411
Mailing Address - Country:US
Mailing Address - Phone:954-821-8545
Mailing Address - Fax:
Practice Address - Street 1:2111 PARKWAY OFFICE CIR STE 150
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2920
Practice Address - Country:US
Practice Address - Phone:954-821-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4724225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics