Healthcare Provider Details

I. General information

NPI: 1548945199
Provider Name (Legal Business Name): BREANNA ALYSSE REBE OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2193 EASTCASTLE DR SE UNIT 103
GRAND RAPIDS MI
49508-7751
US

IV. Provider business mailing address

2193 EASTCASTLE DR SE UNIT 103
GRAND RAPIDS MI
49508-7751
US

V. Phone/Fax

Practice location:
  • Phone: 480-332-4946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: