Provider Demographics
NPI:1710441787
Name:SMONSKEY, BRENDA MAE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MAE
Last Name:SMONSKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MONTEZUMA DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3333
Mailing Address - Country:US
Mailing Address - Phone:703-994-6691
Mailing Address - Fax:
Practice Address - Street 1:2250 JESUS WAY
Practice Address - Street 2:FUNCTIONAL PATHWAYS
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9405
Practice Address - Country:US
Practice Address - Phone:207-459-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15818224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant