Provider Demographics
NPI:1043576275
Name:GULDEN, BRENNEN WALTER (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENNEN
Middle Name:WALTER
Last Name:GULDEN
Suffix:
Gender:M
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 1:7570 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3636
Mailing Address - Country:US
Mailing Address - Phone:952-944-0240
Mailing Address - Fax:952-944-0241
Practice Address - Street 1:7570 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3636
Practice Address - Country:US
Practice Address - Phone:952-944-0240
Practice Address - Fax:952-944-0241
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist