Provider Demographics
NPI:1639397730
Name:HAMELA, BRENDA TERRY (OTR)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:TERRY
Last Name:HAMELA
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 1:3252 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEBREE
Mailing Address - State:KY
Mailing Address - Zip Code:42455-9721
Mailing Address - Country:US
Mailing Address - Phone:812-499-5170
Mailing Address - Fax:270-835-2781
Practice Address - Street 1:3252 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:SEBREE
Practice Address - State:KY
Practice Address - Zip Code:42455-9721
Practice Address - Country:US
Practice Address - Phone:812-499-5170
Practice Address - Fax:270-835-2781
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2838225X00000X
IN31000442A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist