Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 55 | AZ |
NPI | 1164796355 |
---|---|
Provider Name | Andrea Faye Brennan |
First Address | Scottsdale, AZ 85259-3840 |
Second Address | Scottsdale, AZ 85259-3840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 17/12/2021 |