Healthcare Provider Details

I. General information

NPI: 1407902281
Provider Name (Legal Business Name): GLORIA D BRICKENDEN M.A., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

IV. Provider business mailing address

2736 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-1881
  • Fax:
Mailing address:
  • Phone: 954-603-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT8580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: