Provider Demographics
NPI:1477835338
Name:ESSNER, BRENT MICHAEL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:MICHAEL
Last Name:ESSNER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 NORTH HWY 61
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:MO
Mailing Address - Zip Code:63758
Mailing Address - Country:US
Mailing Address - Phone:573-225-7264
Mailing Address - Fax:
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-225-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist