Provider Demographics
NPI:1437893468
Name:HEEREN, BRENNA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:MARIE
Last Name:HEEREN
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 1:1753 ROSEMONT ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2663
Mailing Address - Country:US
Mailing Address - Phone:563-329-0688
Mailing Address - Fax:
Practice Address - Street 1:1401 S 10TH ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1987
Practice Address - Country:US
Practice Address - Phone:563-329-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100168225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist