Healthcare Provider Details

I. General information

NPI: 1235431362
Provider Name (Legal Business Name): BRANDI JO BATTLES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16128 4TH ST E
REDINGTON BEACH FL
33708-1614
US

IV. Provider business mailing address

16128 4TH ST E
REDINGTON BEACH FL
33708-1614
US

V. Phone/Fax

Practice location:
  • Phone: 727-393-5981
  • Fax: 727-393-5986
Mailing address:
  • Phone: 727-393-5981
  • Fax: 727-393-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: