Provider Demographics
NPI:1558591255
Name:KOLLMORGEN, BRENNA (OTR)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:KOLLMORGEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 PARANA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-7115
Mailing Address - Country:US
Mailing Address - Phone:281-888-1502
Mailing Address - Fax:
Practice Address - Street 1:1717 PARANA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-7115
Practice Address - Country:US
Practice Address - Phone:281-888-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist