Provider Demographics
NPI:1942513692
Name:BREWSTER, BRIAN KEITH (OTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NORTH WABASH AVENUE SUITE 200
Mailing Address - Street 2:CREATIVE HEALTH SOLUTIONS
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952
Mailing Address - Country:US
Mailing Address - Phone:765-651-3229
Mailing Address - Fax:765-651-3227
Practice Address - Street 1:4725 SOUTH COLONIAL OAKS DRIVE
Practice Address - Street 2:COLONIAL OAKS HEALTH CARE
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952
Practice Address - Country:US
Practice Address - Phone:765-674-9791
Practice Address - Fax:765-674-2272
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99042975A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant