Provider Demographics
NPI:1033438916
Name:PRITTS, BRENDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PRITTS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 MOSHER WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2437
Mailing Address - Country:US
Mailing Address - Phone:614-893-5159
Mailing Address - Fax:
Practice Address - Street 1:257 MOSHER WAY
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2437
Practice Address - Country:US
Practice Address - Phone:614-893-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9625225X00000X
FL11904225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist