BRENTOM, LLC, (NPI# 1023540531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023540531 |
| Entity Type | Organization |
| Organization Name | BRENTOM, LLC, |
| Other Organization Name | SHARKKS THERAPY |
| Practice Address |
34406 N 27th Dr Ste 140 Phoenix AZ 85085 |
| Mailing Address |
34406 N 27th Dr Ste 140 Phoenix AZ 85085-6079 |
| Practice Telephone | 6234448880 |
| Practice Fax Number | 6234449282 |
| Mailing Telephone | 6234448880 |
| Mailing Fax Number | 6234449282 |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2018-06-19 |
| Authorized Official Name | MR. SHAWN MAURICE WILLIAMS (OCCUPATIONAL THERAPIST/ OWNER) |
| Authorized Official Telephone | 6024308665 |
| Authorized Official Credential | MS, OTR/L |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225XH1200X |
Occupational Therapist Specialization: Hand |
2491 | AZ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 225XM0800X |
Occupational Therapist Specialization: Mental Health |
2491 | AZ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 225XP0019X |
Occupational Therapist Specialization: Physical Rehabilitation |
2491 | AZ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 225XP0200X |
Occupational Therapist Specialization: Pediatrics |
2491 | AZ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 225X00000X | Occupational Therapist | 2491 | AZ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 501032 | 05 |
| Other Name | Type Code |
|---|---|
| SHARKKS Therapy | Doing Business As Name - Organization |
| Therapy Haven | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6635 W Happy Valley Rd, Suite A104-428, Glendale, AZ 853102609 | 6234448880 | 6234449282 |
| Street Address |
34406 N 27TH DR STE 140 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85085 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730447244 | Stephanie Ann Brady | Nurse Practitioner | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2012-05-03 |
| 1407468630 | Matthew Dwight | Marriage & Family Therapist | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2020-08-19 |
| 1255968038 | Andrea Fry | Counselor | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2020-03-24 |
| 1649802828 | Desert Sands Medical Group | Nurse Practitioner | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2020-02-06 |
| 1215582697 | Kaleigh Rhodes | Social Worker | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2019-08-02 |
| 1306333133 | Alan P Ketterling | Marriage & Family Therapist | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2018-04-17 |
| 1891209961 | Dantia Wellness LLC | Marriage & Family Therapist | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2017-11-27 |
| 1700390135 | Nicole Renee Doyle | Social Worker | 34406 N 27th Dr Ste 140, Phoenix, AZ 85085-6079 | 2017-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235748369 | Nicole Fountain | Speech-Language Pathologist | 25700 N. 21st Avenue, Phoenix, AZ 85085 | 2020-07-24 |
| 1083138010 | Larry Leforte II | Emergency Medical Technician, Paramedic | 2018 W Blaylock Dr, Phoenix, AZ 85085 | 2017-08-01 |
| 1508318809 | Jennifer Falk | Chiropractor | 1614 W Whispering Wind Dr Ste 3, Phoenix, AZ 85085 | 2016-11-03 |
| 1053785964 | Cvs Pharmacy | Pharmacy | 28635 N North Vally Parkway, Phoenix, AZ 85085 | 2015-11-17 |
| 1417329897 | Kelly Criswell | Registered Nurse | 32150 N North Foothills Dr, Phoenix, AZ 85085 | 2015-10-26 |
| 1417333717 | Kristi Everett | Social Worker | 34225 N 27th Dr Bldg 5 Ste 146, Phoenix, AZ 85085 | 2015-08-10 |
| 1063849834 | Albertsons Pharmacy | Pharmacist | 2406 W Bramble Berry Ln, Phoenix, AZ 85085 | 2013-10-10 |
| 1427354851 | Carolyn Berg Newsome | Marriage & Family Therapist | 2060 W.whispering Wind Drive, Phoenix, AZ 85085 | 2011-02-02 |
| 1518273127 | Jamie Lynn Born | Social Worker | 34406 N 27th Dr Bldg 6, Phoenix, AZ 85085 | 2010-08-20 |
| 1023347218 | Lise Flores-reed | Psychologist | 34225 N. 27th Drive #110, Phoenix, AZ 85085 | 2009-12-17 |
| Find all providers in zip 85085 | ||||
| Taxonomy Code | 225X00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapist |
| An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699382499 | Alexandra Contreras | Occupational Therapist | 123 W South Mountain Ave, Phoenix, AZ 85041-8102 | 2020-09-25 |
| 1235746249 | Kaitlyn Landess | Occupational Therapist | 1190 W. Missouri Ave, Suite 100, Phoenix, AZ 85014 | 2020-09-24 |
| 1780299958 | Carly Jo Glazier-kersavage | Occupational Therapist | 4225 E Mcdowell Rd Apt 2093, Phoenix, AZ 85008-7472 | 2020-09-14 |
| 1437763513 | Shannon Siemsen | Occupational Therapist | 3011 N 26th St, Phoenix, AZ 85016-7921 | 2020-09-04 |
| 1215540513 | Elissa Marie Leyvas Van Horn | Occupational Therapist | 3237 E Maldonado Dr, Phoenix, AZ 85042-6115 | 2020-08-26 |
| 1679186399 | Rachel Grace Mahon | Occupational Therapist | 15215 S 48th St Ste 145, Phoenix, AZ 85044-9138 | 2020-08-24 |
| 1396384061 | The Little Foundation, LLC | Occupational Therapist | 2745 W Charleston Ave, Phoenix, AZ 85053-1719 | 2019-12-30 |
| 1871132530 | Kristi Sobeck | Occupational Therapist | Synertx Rehab, 7540 N 19th Ave Ste 200, Phoenix, AZ 85021-7967 | 2019-12-29 |
| 1023656196 | Matthew Figgins | Occupational Therapist | 15215 S 48th St Unit 145, Phoenix, AZ 85044-9142 | 2019-12-19 |
| 1366089096 | Kyle Bradley Burklund | Occupational Therapist | 6550 W Andrea Dr, Phoenix, AZ 85083-6518 | 2019-12-02 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.