Healthcare Provider Details

I. General information

NPI: 1174862759
Provider Name (Legal Business Name): MR. ROBERT ALAN BRUMMETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 VICTORIA ST
BRANDON FL
33510-4100
US

IV. Provider business mailing address

701 VICTORIA ST
BRANDON FL
33510-4100
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-4220
  • Fax: 813-689-5685
Mailing address:
  • Phone: 813-681-4220
  • Fax: 813-689-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 1672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: