Provider Demographics
NPI:1497830335
Name:BOETTCHER, BRENDA LEE (NCMT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 BOARDWALK ST.
Mailing Address - Street 2:#3
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-9403
Mailing Address - Country:US
Mailing Address - Phone:715-514-1339
Mailing Address - Fax:
Practice Address - Street 1:517 E CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6479
Practice Address - Country:US
Practice Address - Phone:715-855-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2271-046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist