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General NPI Number Information
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NPI Number | 1023540531
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Entity Type | Organization
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Legal Business Name | BRENTOM, LLC,
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 20783 N 83RD AVE STE 103
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City | PEORIA
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State | AZ
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Zip | 85382-7430
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Country | US
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Telephone | 623-444-8880
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Fax | 623-444-9282
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Provider Business Mailing Address
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Address Line | 20783 N 83RD AVE STE 103
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City | PEORIA
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State | AZ
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Zip | 85382-7430
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Country | US
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Telephone | 623-444-8880
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Fax | 623-444-9282
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/ OWNER
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Name | MR. SHAWN MAURICE WILLIAMS
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Credential | MS, OTR/L
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Telephone | 602-430-8665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 2491
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | 2491
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 2491
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 2491
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License Number State | AZ
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Taxonomy #7
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2491
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License Number State | AZ
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