Provider Demographics
NPI:1033405352
Name:BREMER, MARY ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BREMER
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 1:25266 BIRCH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6417
Mailing Address - Country:US
Mailing Address - Phone:949-455-2550
Mailing Address - Fax:
Practice Address - Street 1:16269 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3603
Practice Address - Country:US
Practice Address - Phone:949-788-9236
Practice Address - Fax:949-788-9246
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5561225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist