Provider Demographics
NPI:1114030103
Name:ALDRIDGE, BRENDA VENITA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:VENITA
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:VENITA
Other - Last Name:FELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10609 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2488
Mailing Address - Country:US
Mailing Address - Phone:501-257-6422
Mailing Address - Fax:501-257-6419
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6422
Practice Address - Fax:501-257-6419
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist