Provider Demographics
NPI:1982974044
Name:SNOW, BRENDA JEAN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:SNOW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KIMBERLY LANE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097
Mailing Address - Country:US
Mailing Address - Phone:859-823-0406
Mailing Address - Fax:859-823-0458
Practice Address - Street 1:201 KIMBERLY LANE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097
Practice Address - Country:US
Practice Address - Phone:859-823-0406
Practice Address - Fax:859-823-0458
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA2114224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant