Provider Demographics
NPI:1114664760
Name:SHIELDS, BRENNA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:LYNN
Last Name:SHIELDS
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 1:4752 BRIAN RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3011
Mailing Address - Country:US
Mailing Address - Phone:484-894-3947
Mailing Address - Fax:
Practice Address - Street 1:4752 BRIAN RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3011
Practice Address - Country:US
Practice Address - Phone:484-894-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist