Provider Demographics
NPI:1477695518
Name:BRENNAN, KELLY (OT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BRENNAN
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 1:2322 W GAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4014
Mailing Address - Country:US
Mailing Address - Phone:480-664-6843
Mailing Address - Fax:
Practice Address - Street 1:1238 E CHANDLER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4601
Practice Address - Country:US
Practice Address - Phone:480-704-5954
Practice Address - Fax:480-704-5807
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist