Provider Demographics
NPI:1912338211
Name:BREERWOOD, ALIZA
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:BREERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:KRUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2905 SEDGEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2905 SEDGEFIELD CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7627
Practice Address - Country:US
Practice Address - Phone:443-540-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15594225X00000X
SC4806225X00000X
CA13533225X00000X
MD07023225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist