Healthcare Provider Details

I. General information

NPI: 1619943917
Provider Name (Legal Business Name): KATHRYN BRANDT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
SACO ME
04072-1699
US

IV. Provider business mailing address

PO BOX 284
BRATTLEBORO VT
05302-0284
US

V. Phone/Fax

Practice location:
  • Phone: 207-602-3571
  • Fax: 207-602-3573
Mailing address:
  • Phone: 207-602-3571
  • Fax: 207-602-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1633
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1633
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1633
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: