Provider Demographics
NPI:1104105303
Name:PEDERSEN, BRENDA K (BSOT, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:BSOT, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1414
Mailing Address - Country:US
Mailing Address - Phone:515-471-9292
Mailing Address - Fax:
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-471-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00558225X00000X
CA9911000064225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand