Provider Demographics
NPI:1558028514
Name:BREWER, ELEANOR (OTR/L)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9666 GRUWELL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2448
Mailing Address - Country:US
Mailing Address - Phone:916-549-6573
Mailing Address - Fax:
Practice Address - Street 1:2905 REYNOLDS RANCH PKWY
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6866
Practice Address - Country:US
Practice Address - Phone:209-310-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist