Healthcare Provider Details

I. General information

NPI: 1023162526
Provider Name (Legal Business Name): MISS BRANDEE RENEE SWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TONINA CV
MAITLAND FL
32751-3442
US

IV. Provider business mailing address

4725 NEW BROAD ST APT 308
ORLANDO FL
32814-6429
US

V. Phone/Fax

Practice location:
  • Phone: 407-388-0246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT12279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: