Provider Demographics
NPI:1326573098
Name:SANTERAMO, BRECHEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:BRECHEN
Middle Name:
Last Name:SANTERAMO
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 WIDGEON DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9272
Mailing Address - Country:US
Mailing Address - Phone:970-587-8281
Mailing Address - Fax:
Practice Address - Street 1:2043 WIDGEON DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9272
Practice Address - Country:US
Practice Address - Phone:970-587-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12681225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist