Healthcare Provider Details

I. General information

NPI: 1225466154
Provider Name (Legal Business Name): BRANDY LUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 W PLAZA DR
TALLAHASSEE FL
32308-5325
US

IV. Provider business mailing address

2410 W PLAZA DR
TALLAHASSEE FL
32308-5325
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-6185
  • Fax: 850-385-2580
Mailing address:
  • Phone: 805-385-6185
  • Fax: 850-385-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA12865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: