Provider Demographics
NPI:1942444112
Name:BREWINGTON, JANEAN CAROL
Entity Type:Individual
Prefix:
First Name:JANEAN
Middle Name:CAROL
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANEAN
Other - Middle Name:CAROL
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:310 S CECIL ST
Mailing Address - Street 2:
Mailing Address - City:BONDUEL
Mailing Address - State:WI
Mailing Address - Zip Code:54107-9260
Mailing Address - Country:US
Mailing Address - Phone:920-290-0152
Mailing Address - Fax:
Practice Address - Street 1:1436 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3427
Practice Address - Country:US
Practice Address - Phone:715-526-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4473-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist