Provider Demographics
NPI:1578385373
Name:MENDELL, BREANNA V (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:V
Last Name:MENDELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2166
Mailing Address - Country:US
Mailing Address - Phone:401-432-5100
Mailing Address - Fax:
Practice Address - Street 1:31 HAYWARD ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2166
Practice Address - Country:US
Practice Address - Phone:401-432-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15518225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics