MEDICARE: MS. BRENDA LEE KLINGAMAN P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2278S1500X	SNF/Subacute Care Certified Respiratory Therapist	240019	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144425976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA LEE KLINGAMAN P.T.A.

Provider Business Mailing Address
First Line	:	W758 NORWAY DR
Second Line	:
City	:	FALL RIVER
State	:	WI
Zip	:	53932-8919
Country	:	US
Telephone Number	:	920-484-3363
Fax Number	:

Provider Business Practice Location Address
First Line	:	W758 NORWAY DR
Second Line	:
City	:	FALL RIVER
State	:	WI
Zip	:	53932-8919
Country	:	US
Telephone Number	:	920-484-3363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	06/03/2008

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