Provider Demographics
NPI:1477693943
Name:MEINEN, BRENDA MARY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARY
Last Name:MEINEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1257
Mailing Address - Country:US
Mailing Address - Phone:715-568-2000
Mailing Address - Fax:
Practice Address - Street 1:1501 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1257
Practice Address - Country:US
Practice Address - Phone:715-568-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI611-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40620900Medicaid
WI40620900Medicaid