Provider Demographics
NPI:1801320213
Name:WALL, BRENDAN GREENHOUSE (OTR/L)
Entity type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:GREENHOUSE
Last Name:WALL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 W BARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2437
Mailing Address - Country:US
Mailing Address - Phone:720-289-3856
Mailing Address - Fax:
Practice Address - Street 1:12213 PECOS ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3412
Practice Address - Country:US
Practice Address - Phone:720-289-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist