Provider Demographics
NPI:1598111726
Name:TANKO, BRENNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:TANKO
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 1:3601 PARK CENTER BLVD
Mailing Address - Street 2:APT 916
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2531
Mailing Address - Country:US
Mailing Address - Phone:414-202-5126
Mailing Address - Fax:
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-417-5751
Practice Address - Fax:608-417-5315
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist