Brennah Mae Fulton, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

107120 Issued in MN

Practice address

9220 Bass Lake Rd Ste 260
New Hope, MN 55428-3019

Phone

(763) 533-0363

NPI assigned

Mar 16, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  NPD
• Higher Ground Pediatric Therapy, PLLC

  • Occupational Therapist
  • Arden, NC
  • NPI 1710288378
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1134820160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 EMERSON AVE S APT 2",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082774",
            "telephone_number": "715-581-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 BASS LAKE RD STE 260",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283019",
            "telephone_number": "763-533-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "BRENNAH",
        "middle_name": "MAE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "107120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Flores Robles, MFT
• Sherri Lee Ford, COTA/L
• Matthew Clay Freudenthal, D.C.
• Frontline Mobility LLC
• Frontline Recovery LLC
• Lizeth Gallini-Matyas
• Erica Gathje, M.D.
• Rachel Gatlin
• Kelsey Ann Gaul, LICSW
• Queen Gbor Hill, CNP

• Occupational Therapist in New Hope, MN
• Providers in New Hope, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.