Healthcare Provider Details

I. General information

NPI: 1912822008
Provider Name (Legal Business Name): BRENNA DARVAS MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HIGH ST
BURLINGTON NJ
08016-4526
US

IV. Provider business mailing address

73 BOWNE STATION RD
STOCKTON NJ
08559-1906
US

V. Phone/Fax

Practice location:
  • Phone: 609-387-5834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01178700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: