Provider Demographics
NPI:1508876251
Name:BREXA, ANN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BREXA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:BREXA
Other - Last Name:HOOSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:6979 S HOLLY CIR
Mailing Address - Street 2:STE 105
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1577
Mailing Address - Country:US
Mailing Address - Phone:303-694-2295
Mailing Address - Fax:303-694-1843
Practice Address - Street 1:1551 PROFESSIONAL LN
Practice Address - Street 2:#145
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6972
Practice Address - Country:US
Practice Address - Phone:720-494-3290
Practice Address - Fax:720-494-3294
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AA451260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102072963OtherOWCP FACILITY ID
102072963OtherOWCP FACILITY ID