Provider Demographics
NPI:1114659505
Name:BRENDEL, ELLIE NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:NICOLE
Last Name:BRENDEL
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 1:21812 S BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-6004
Mailing Address - Country:US
Mailing Address - Phone:248-977-8338
Mailing Address - Fax:
Practice Address - Street 1:604 LUCAS RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6623
Practice Address - Country:US
Practice Address - Phone:910-891-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist