Most Relevant Information
Provider Data
| NPI Number: | 1003647074 |
| Provider Name: | BREENA RAE BRNCICH OTD, OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225XP0200X |
| Specialty: | Occupational Therapist |
| License Number: | 056.016146 |
Most Important Dates
| Enumeration Date: | 08/12/2024 |
| Last Updated: | 08/12/2024 |
Provider Practice Location
3002 E DIVISION ST
DIAMOND
IL
604169486
Practice Location Phone/Fax
| Phone: | 8153905366 |
| Fax: |
Provider Mailing Location
27425 S WILL RD
WILMINGTON
IL
604818352
Provider Mailing Phone/Fax
| Phone: | 8156939612 |
| Fax: |