Provider Demographics
NPI:1013594712
Name:CASEY, BRENNA (OT)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N REED ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5933
Mailing Address - Country:US
Mailing Address - Phone:779-225-4525
Mailing Address - Fax:
Practice Address - Street 1:3100 DUNDEE RD STE 704
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2442
Practice Address - Country:US
Practice Address - Phone:847-663-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist