MEDICARE: BRENNA VALERO OTR/L

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	225X00000X	Occupational Therapist	OT21578	FL

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	:	1760073571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA VALERO OTR/L

Provider Business Mailing Address
First Line	:	5117 GREENWAY DR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-4603
Country	:	US
Telephone Number	:	973-216-2602
Fax Number	:	352-241-6361

Provider Business Practice Location Address
First Line	:	2103 GILMORE ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3211
Country	:	US
Telephone Number	:	904-906-3878
Fax Number	:

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	06/05/2025

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