Provider Demographics
NPI:1083432793
Name:BREWSTER, BRIANNA MICHELE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MICHELE
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 E 5TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5436
Mailing Address - Country:US
Mailing Address - Phone:515-556-0955
Mailing Address - Fax:
Practice Address - Street 1:600 E COURT AVE STE 120
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2068
Practice Address - Country:US
Practice Address - Phone:515-979-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist