Individual
NICOLE BREDBENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1131 E LAKEWOOD ST, SPRINGFIELD, MO 65810-2471
(417) 631-4659
Mailing address
3945 S PARKCREST AVE, SPRINGFIELD, MO 65807-4666
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2022006216
MO
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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