Healthcare Provider Details

I. General information

NPI: 1891963823
Provider Name (Legal Business Name): BRANDI MARIE FOLK OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI MARIE FRAZEE OTRL

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 THAYER CTR
OAKLAND MD
21550-1116
US

IV. Provider business mailing address

6500 THAYER CTR
OAKLAND MD
21550-1116
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-1863
  • Fax: 301-334-5835
Mailing address:
  • Phone: 301-334-1863
  • Fax: 301-334-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05091
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number1154
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: