Provider Demographics
NPI:1194365783
Name:CHOUINARD, BRENDA GRACE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:GRACE
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BUTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1825
Mailing Address - Country:US
Mailing Address - Phone:413-219-9137
Mailing Address - Fax:
Practice Address - Street 1:21 BUTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1825
Practice Address - Country:US
Practice Address - Phone:413-219-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA530343224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant