Provider Demographics
NPI:1346751005
Name:WHALEN, BRENNA (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ATLANTIC AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-9163
Mailing Address - Country:US
Mailing Address - Phone:302-537-7488
Mailing Address - Fax:
Practice Address - Street 1:118 ATLANTIC AVE STE 302
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9163
Practice Address - Country:US
Practice Address - Phone:302-537-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015378225X00000X
DEU1-0012347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist