Provider Demographics
NPI:1689342610
Name:SLAGH, BREANNA MAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:MAY
Last Name:SLAGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:MAY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7230 JACKSON CREEK PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:719-597-0822
Mailing Address - Fax:
Practice Address - Street 1:7230 JACKSON CREEK PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-597-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OT.0006885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist