Provider Demographics
NPI:1770512147
Name:EWER, BRENDA K (OT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:EWER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2641
Mailing Address - Country:US
Mailing Address - Phone:305-853-0943
Mailing Address - Fax:
Practice Address - Street 1:200 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2641
Practice Address - Country:US
Practice Address - Phone:305-853-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10819225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26-4091162OtherTAX ID #