Provider Demographics
NPI:1285929489
Name:ZELLER, BRENDA JO (COTA)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JO
Last Name:ZELLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22459 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BELVUE
Mailing Address - State:KS
Mailing Address - Zip Code:66407-9406
Mailing Address - Country:US
Mailing Address - Phone:785-456-3105
Mailing Address - Fax:
Practice Address - Street 1:22459 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:BELVUE
Practice Address - State:KS
Practice Address - Zip Code:66407-9406
Practice Address - Country:US
Practice Address - Phone:785-456-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00327313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility