Provider Demographics
NPI:1629778782
Name:TREIHEL, BRENT JOHN (COTA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:JOHN
Last Name:TREIHEL
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 W REDDING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5030
Mailing Address - Country:US
Mailing Address - Phone:559-936-0329
Mailing Address - Fax:
Practice Address - Street 1:1101 STROUD AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1016
Practice Address - Country:US
Practice Address - Phone:559-897-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant