Provider Demographics
NPI:1760638670
Name:BODINE, BRENDA (OT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BODINE
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 1:1000 WHITE HORSE RD STE 608
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4412
Mailing Address - Country:US
Mailing Address - Phone:856-435-6332
Mailing Address - Fax:856-435-6174
Practice Address - Street 1:1000 WHITE HORSE RD STE 608
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4412
Practice Address - Country:US
Practice Address - Phone:856-435-6332
Practice Address - Fax:856-435-6174
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00475100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist