Healthcare Provider Details

I. General information

NPI: 1922597053
Provider Name (Legal Business Name): SAMANTHA LYNN BRAND MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 A NORTH MAIN ST
SUNDERLAND MA
01375
US

IV. Provider business mailing address

54 MAPLE ST
EASTHAMPTON MA
01027-1755
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax: 413-665-9383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12682
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: