Individual
BRENDA LOU RUTHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
437 FOX RUN, DEBARY, FL 32713-4622
(407) 453-2885
Mailing address
437 FOX RUN, DEBARY, FL 32713-4622
(386) 668-7899
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
976
FL
225XP0200X
Pediatric Occupational Therapist
OT 976
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
880177100
—
FL
Enumeration date
01/30/2007
Last updated
12/10/2020
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