Provider Demographics
NPI:1093345225
Name:DRISCOLL, BRENNA MAEVE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:MAEVE
Last Name:DRISCOLL
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 1:103 PAUGUSETT CIR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4575
Mailing Address - Country:US
Mailing Address - Phone:508-364-4399
Mailing Address - Fax:
Practice Address - Street 1:455 POST RD STE 202
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3614
Practice Address - Country:US
Practice Address - Phone:203-424-2584
Practice Address - Fax:203-255-1173
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5343225X00000X
MA13427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist