=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932338795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA MARIE TRI CRT,EI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2009
-----------------------------------------------------
Last Update Date | 07/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2051 MAIN ST
-----------------------------------------------------
City | WEST BARNSTABLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02668-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-400-0011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2051 MAIN ST
-----------------------------------------------------
City | WEST BARNSTABLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02668-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-400-0011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 3924
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225CX0006X
-----------------------------------------------------
Taxonomy Name | Orientation and Mobility Training Rehabilitation Counselor
-----------------------------------------------------
License Number | 3103
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 3103
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------