Provider Demographics
NPI:1457470098
Name:SMAGA, BRENDA (MS, OTR-L, FAOTA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:SMAGA
Suffix:
Gender:F
Credentials:MS, OTR-L, FAOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 RAMPART DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3366
Mailing Address - Country:US
Mailing Address - Phone:860-657-8282
Mailing Address - Fax:
Practice Address - Street 1:72 SALMON BROOK DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2131
Practice Address - Country:US
Practice Address - Phone:860-633-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist