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Individual

MRS. BRENDA J PARDY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
BS

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005499A
IN
225X00000X
Occupational Therapist
OT0001528
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
21053537
CO
01
IN2091
MEDICARE PTAN IN2091
IN
Enumeration date
04/21/2006
Last updated
01/12/2016
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