Individual
BRENNAH MAE FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
9220 BASS LAKE RD STE 260, NEW HOPE, MN 55428-3019
(763) 533-0363
Mailing address
3116 EMERSON AVE S APT 2, MINNEAPOLIS, MN 55408-2774
(715) 581-6268
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
107120
MN
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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