Provider Demographics
NPI:1336332634
Name:BRENNAN, MARYANN B (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:B
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HONEYSUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1763
Mailing Address - Country:US
Mailing Address - Phone:610-358-4404
Mailing Address - Fax:
Practice Address - Street 1:5 HONEYSUCKLE CT
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1763
Practice Address - Country:US
Practice Address - Phone:610-358-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003300L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019333280002Medicaid