Provider Demographics
NPI:1881788859
Name:ROSSETTI, BRENDA (COTA / L)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:ROSSETTI
Suffix:
Gender:F
Credentials:COTA / L
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:5121 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-507-7571
Mailing Address - Fax:
Practice Address - Street 1:5121 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant