Provider Demographics
NPI:1235240243
Name:CHILSTROM, BRENDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CHILSTROM
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 1:102 PEBBLE SHORES DR
Mailing Address - Street 2:#201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9259
Mailing Address - Country:US
Mailing Address - Phone:239-455-9525
Mailing Address - Fax:
Practice Address - Street 1:5860 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7459
Practice Address - Country:US
Practice Address - Phone:239-455-9525
Practice Address - Fax:239-455-2844
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist