Provider Demographics
NPI:1548778889
Name:PELTZ, BRENDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PELTZ
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 1:75 N WOODWARD AVE # 84356
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32313-7500
Mailing Address - Country:US
Mailing Address - Phone:813-334-1036
Mailing Address - Fax:
Practice Address - Street 1:75 N WOODWARD AVE # 84356
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32313-7500
Practice Address - Country:US
Practice Address - Phone:813-334-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist