Provider Demographics
NPI:1194235838
Name:EARLEY, BRENNA MARIE
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:MARIE
Last Name:EARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:MARIE
Other - Last Name:EARLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15620 SWAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-8721
Mailing Address - Country:US
Mailing Address - Phone:989-245-9602
Mailing Address - Fax:
Practice Address - Street 1:15620 SWAN CREEK RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-8721
Practice Address - Country:US
Practice Address - Phone:989-245-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007939225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201007939OtherOCCUPATIONAL THERAPY LICENSE