Provider Demographics
NPI:1205474970
Name:KASPER, BREANA KATE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:KATE
Last Name:KASPER
Suffix:
Gender:
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:BREANA
Other - Middle Name:KATE
Other - Last Name:STANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1509 SOUTHCROSS DR W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14301 EWING AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4885
Practice Address - Country:US
Practice Address - Phone:952-746-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2025-03-03
Deactivation Date:2024-10-23
Deactivation Code:
Reactivation Date:2025-03-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician