Provider Demographics
NPI:1467252122
Name:COLLINS, BRENDA MARILIA (OTDR/L)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARILIA
Last Name:COLLINS
Suffix:
Gender:
Credentials:OTDR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E ASHURST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-2032
Mailing Address - Country:US
Mailing Address - Phone:224-321-6663
Mailing Address - Fax:
Practice Address - Street 1:3033 N 44TH ST STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7244
Practice Address - Country:US
Practice Address - Phone:623-263-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-009919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist