Provider Demographics
NPI:1134368178
Name:BECKMAN, BRENDA S (OTR/L)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:BROKAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:801 SW FAIRLAWN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2338
Practice Address - Country:US
Practice Address - Phone:785-228-1700
Practice Address - Fax:785-273-0716
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200594510CMedicaid
KSKA2037046Medicare PIN