Deidre Dale Brinegar

Individual provider Active NPI Occupational Therapist · Mexico, MO

NPI 1629137864 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1629137864
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapist 225X00000X
License
2001016829 (MO)
Practice address
222 E Jackson St
Mexico, MO 65265-2821
Phone
(573) 581-3000
Fax
(573) 581-0888
NPI assigned
Dec 6, 2006
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2001016829MOMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Rehabilitation, LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2001016829 MO Yes

Addresses

Primary practice location

222 E Jackson St
Mexico, MO 65265-2821

Mailing address

169 Highway Aa
Wellsville, MO 63384-3706
Phone (573) 581-3000

Other providers in Mexico, MO

All providers in Mexico, MO · Occupational Therapist in Missouri

Sources for this page

Verify at the official NPI Registry.