Provider Demographics
NPI:1184487761
Name:ROSENBERRY, BRENNA CHRISTINE (COTA/L)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:CHRISTINE
Last Name:ROSENBERRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9200
Mailing Address - Country:US
Mailing Address - Phone:717-860-9152
Mailing Address - Fax:
Practice Address - Street 1:1070 STOUFFER AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2938
Practice Address - Country:US
Practice Address - Phone:717-263-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010424224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant