Provider Demographics
NPI:1497364863
Name:BREYER, JARED J SR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:J
Last Name:BREYER
Suffix:SR
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 1:4722 KERSHNER AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3280
Mailing Address - Country:US
Mailing Address - Phone:843-906-9951
Mailing Address - Fax:
Practice Address - Street 1:4722 KERSHNER AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3280
Practice Address - Country:US
Practice Address - Phone:843-906-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK164124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist