Provider Demographics
NPI:1417671454
Name:BRUMBAUGH, BRETT LUCAS
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:LUCAS
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MASSASOIT AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2040
Mailing Address - Country:US
Mailing Address - Phone:401-490-7610
Mailing Address - Fax:
Practice Address - Street 1:400 MASSASOIT AVE STE 113
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2040
Practice Address - Country:US
Practice Address - Phone:401-490-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist