Provider Demographics
NPI:1396186763
Name:BURNETT, BRENDA ELAINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELAINE
Last Name:BURNETT
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 1:1914 13TH AVE W
Mailing Address - Street 2:APT 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2772
Mailing Address - Country:US
Mailing Address - Phone:206-285-9028
Mailing Address - Fax:
Practice Address - Street 1:1914 13TH AVE W
Practice Address - Street 2:APT 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2772
Practice Address - Country:US
Practice Address - Phone:206-285-9028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60334899225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist