Provider Demographics
NPI:1346646742
Name:HENSLEY, BREANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6852 STONETRACE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5095
Mailing Address - Country:US
Mailing Address - Phone:505-379-5513
Mailing Address - Fax:
Practice Address - Street 1:1548 OTERO VALLEY CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-2962
Practice Address - Country:US
Practice Address - Phone:505-379-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14-0518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist