MEDICARE: BRANDI CHAMPION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	284181	KY
2	224Z00000X	Occupational Therapy Assistant	165229	KY

General Provider Information

NPI Number	:	1700341849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI CHAMPION

Provider Business Mailing Address
First Line	:	51016 US 62
Second Line	:
City	:	MAYSLICK
State	:	KY
Zip	:	41055-8826
Country	:	US
Telephone Number	:	606-407-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 OLD MAIN ST
Second Line	:
City	:	MAYSVILLE
State	:	KY
Zip	:	41056-8984
Country	:	US
Telephone Number	:	606-956-0535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2019
Last Update Date	:	04/03/2023

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Directions to “ BRANDI CHAMPION ” Practice Location

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