Provider Demographics
NPI:1407019029
Name:BREKKE, SHAUNDA MARIE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:SHAUNDA
Middle Name:MARIE
Last Name:BREKKE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:SHAUNDA
Other - Middle Name:MARIE
Other - Last Name:WHALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:900 W 94TH ST
Mailing Address - Street 2:THE THERAPY PLACE
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420
Mailing Address - Country:US
Mailing Address - Phone:952-885-0418
Mailing Address - Fax:952-885-0173
Practice Address - Street 1:900 W 94TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-885-0418
Practice Address - Fax:952-885-0173
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist