Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00872600 | NJ |
NPI | 1386205482 |
---|---|
Provider Name | Kristina Brenner |
First Address | Mount Laurel, NJ 08054-3414 |
Second Address | Mount Laurel, NJ 08054-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |