Provider Demographics
NPI:1467226423
Name:GREAVES, BRENDA MICHELLE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MICHELLE
Last Name:GREAVES
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 1:11705 FISHER HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1112
Mailing Address - Country:US
Mailing Address - Phone:402-215-6684
Mailing Address - Fax:
Practice Address - Street 1:1335 NW BROAD ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4428
Practice Address - Country:US
Practice Address - Phone:888-362-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist