Provider Demographics
NPI:1881720449
Name:STAPEL, BRENDA LEE (MS, OT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:STAPEL
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
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Mailing Address - Street 1:4214 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-4142
Mailing Address - Country:US
Mailing Address - Phone:262-554-5006
Mailing Address - Fax:262-554-6892
Practice Address - Street 1:4214 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-4142
Practice Address - Country:US
Practice Address - Phone:262-554-5006
Practice Address - Fax:262-554-6892
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3998-026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40854100Medicaid
WI3998-026OtherSTATE OF WI OT LICENSE