Provider Demographics
NPI:1356672414
Name:HENDRICKS, BRENDA KAE (OTA)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 LAKE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8090
Mailing Address - Country:US
Mailing Address - Phone:239-481-6615
Mailing Address - Fax:239-481-6654
Practice Address - Street 1:7460 LAKE BREEZE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8090
Practice Address - Country:US
Practice Address - Phone:239-481-6615
Practice Address - Fax:239-481-6654
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10806224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant