Provider Demographics
NPI:1144687427
Name:PEIFFER CORAM, BRENDA SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:PEIFFER CORAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:CORAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13 BEAR CREEK ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-8996
Mailing Address - Country:US
Mailing Address - Phone:641-680-5264
Mailing Address - Fax:
Practice Address - Street 1:13 BEAR CREEK ESTATES DR
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-8996
Practice Address - Country:US
Practice Address - Phone:641-680-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00668174400000X, 225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation