Provider Demographics
NPI:1558814723
Name:CHEYNE, BRENT ROBERT (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ROBERT
Last Name:CHEYNE
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 50TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-4903
Mailing Address - Country:US
Mailing Address - Phone:941-779-7824
Mailing Address - Fax:
Practice Address - Street 1:3911 GOLF PARK LOOP STE 105
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3453
Practice Address - Country:US
Practice Address - Phone:941-756-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist