Provider Demographics
NPI:1467975904
Name:DENNIS, BREANNA (OT)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 E MISSOURI AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2719
Mailing Address - Country:US
Mailing Address - Phone:602-393-0520
Mailing Address - Fax:602-393-0523
Practice Address - Street 1:1190 E MISSOURI AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2719
Practice Address - Country:US
Practice Address - Phone:602-393-0520
Practice Address - Fax:602-393-0523
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist