Provider Demographics
NPI:1659566172
Name:LOSON, BRENDA VICTORIA (MA, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:VICTORIA
Last Name:LOSON
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E DEL MAR BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2544
Mailing Address - Country:US
Mailing Address - Phone:626-564-2700
Mailing Address - Fax:
Practice Address - Street 1:200 E DEL MAR BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2544
Practice Address - Country:US
Practice Address - Phone:626-564-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 13689225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics