Provider Demographics
NPI:1144425976
Name:KLINGAMAN, BRENDA LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:KLINGAMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:KLINGAMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:W758 NORWAY DR
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53932-8919
Mailing Address - Country:US
Mailing Address - Phone:920-484-3363
Mailing Address - Fax:
Practice Address - Street 1:W758 NORWAY DR
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:WI
Practice Address - Zip Code:53932-8919
Practice Address - Country:US
Practice Address - Phone:920-484-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2400192278S1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedSNF/Subacute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40029100Medicaid