Provider Demographics
NPI:1154820488
Name:BREGAR, BRANDY (OTR, NHA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BREGAR
Suffix:
Gender:F
Credentials:OTR, NHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 TIERRA BERIENDA
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2610
Mailing Address - Country:US
Mailing Address - Phone:303-908-2856
Mailing Address - Fax:
Practice Address - Street 1:1718 TIERRA BERIENDA
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2610
Practice Address - Country:US
Practice Address - Phone:303-908-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XE0001X
COOT.0001394225XG0600X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology