Provider Demographics
NPI:1770549446
Name:PARDY, BRENDA J (BS)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:PARDY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10938 S COUNTY ROAD 150 W
Mailing Address - Street 2:
Mailing Address - City:ENGLISH
Mailing Address - State:IN
Mailing Address - Zip Code:47118-7873
Mailing Address - Country:US
Mailing Address - Phone:812-788-1118
Mailing Address - Fax:888-371-6163
Practice Address - Street 1:10 E COURT ST
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-1321
Practice Address - Country:US
Practice Address - Phone:812-788-1118
Practice Address - Fax:888-371-6163
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005499A225X00000X
COOT0001528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21053537Medicaid
ININ2091OtherMEDICARE PTAN IN2091
COC487658Medicare ID - Type Unspecified