Individual
BRENDA MARIE SOUTHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3915 QUITMAN ST, DENVER, CO 80212-2123
(303) 638-2370
Mailing address
1623 BEULAH AVE, PUEBLO, CO 81004-2703
(719) 671-9417
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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