Provider Demographics
NPI:1538499751
Name:BRENNAN, SUZANNE ELAINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELAINE
Last Name:BRENNAN
Suffix:
Gender:F
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 1:124 OLD CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7881
Mailing Address - Country:US
Mailing Address - Phone:757-564-1867
Mailing Address - Fax:
Practice Address - Street 1:3900 WINDSOR HALL DR
Practice Address - Street 2:F235
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2875
Practice Address - Country:US
Practice Address - Phone:757-229-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119001914OtherLICENSE