Provider Demographics
NPI:1629009394
Name:GEORGE, BRENDA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:GEORGE
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 1:7380 LITHOPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9732
Mailing Address - Country:US
Mailing Address - Phone:740-687-5949
Mailing Address - Fax:749-687-5949
Practice Address - Street 1:7380 LITHOPOLIS RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9732
Practice Address - Country:US
Practice Address - Phone:740-687-5949
Practice Address - Fax:749-687-5949
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT0173225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics