Provider Demographics
NPI:1740068154
Name:WHALEN, BREANAN MARIE
Entity type:Individual
Prefix:
First Name:BREANAN
Middle Name:MARIE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ABERDEEN RD APT 11
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1170
Mailing Address - Country:US
Mailing Address - Phone:732-865-2369
Mailing Address - Fax:
Practice Address - Street 1:130 ABERDEEN RD APT 11
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1170
Practice Address - Country:US
Practice Address - Phone:732-865-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01139500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist