Provider Demographics
NPI:1447835566
Name:MIRENDA, BRIANNA E (OT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:E
Last Name:MIRENDA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NEW LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4958
Mailing Address - Country:US
Mailing Address - Phone:508-856-9510
Mailing Address - Fax:508-853-1907
Practice Address - Street 1:225 NEW LANCASTER RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4958
Practice Address - Country:US
Practice Address - Phone:508-856-9510
Practice Address - Fax:508-853-1907
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist