Provider Demographics
NPI:1588113138
Name:BRENNAN, AMANDA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:
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 1:3050 VALLEY VW NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9121
Mailing Address - Country:US
Mailing Address - Phone:810-923-2260
Mailing Address - Fax:
Practice Address - Street 1:3050 VALLEY VW NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9121
Practice Address - Country:US
Practice Address - Phone:810-923-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist