Provider Demographics
NPI:1942633060
Name:BROMELAND, ANNA LEA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEA
Last Name:BROMELAND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MCDEVITT ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2248
Mailing Address - Country:US
Mailing Address - Phone:612-385-1896
Mailing Address - Fax:
Practice Address - Street 1:530 MCDEVITT ST
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2248
Practice Address - Country:US
Practice Address - Phone:612-385-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103344225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology