Healthcare Provider Details

I. General information

NPI: 1336332634
Provider Name (Legal Business Name): MARYANN B. BRENNAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 SUNRIDGE DR
SUNSET BEACH NC
28468-2400
US

IV. Provider business mailing address

1115 SUNRIDGE DR
SUNSET BEACH NC
28468-2400
US

V. Phone/Fax

Practice location:
  • Phone: 610-639-1814
  • Fax:
Mailing address:
  • Phone: 610-639-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number15346
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC003300L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: