Active NPI
Richard John Brenza III, OTR/L
- Occupational Therapist
- New Lenox, IL
National Provider Identifier
1992266894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.012918
- Practice address
- 1361 E Lincoln Hwy
New Lenox, IL 60451-2153 - Phone
- (815) 463-0719
- NPI assigned
- Mar 25, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.012918 | IL | Primary |
Addresses
Primary practice location
1361 E Lincoln Hwy
New Lenox, IL 60451-2153
Mailing address
23762 Springs CT Unit 108
Plainfield, IL 60585-2280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.012918 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553472000000",
"number": "1992266894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23762 SPRINGS CT UNIT 108",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605852280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1361 E LINCOLN HWY",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604512153",
"telephone_number": "815-463-0719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENZA",
"first_name": "RICHARD",
"middle_name": "JOHN",
"name_suffix": "III",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-25",
"last_updated": "2019-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.012918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.