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General NPI Number Information
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NPI Number | 1679221113
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Entity Type | Individual
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Provider Name | BRENNAN MICHAEL NEWBERRY
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Gender | Male
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 400 N STEPHANIE ST STE 310
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City | HENDERSON
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State | NV
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Zip | 89014-6608
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Country | US
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Telephone | 702-454-1162
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N STEPHANIE ST STE 310
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City | HENDERSON
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State | NV
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Zip | 89014-6608
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Country | US
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Telephone | 702-454-1162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2945
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License Number State | NV
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