Healthcare Provider Details

I. General information

NPI: 1164822102
Provider Name (Legal Business Name): BRANDY SHERI BRANTLEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 S DEACON ST
DETROIT MI
48217-1636
US

IV. Provider business mailing address

2241 S DEACON ST
DETROIT MI
48217-1636
US

V. Phone/Fax

Practice location:
  • Phone: 313-412-6469
  • Fax:
Mailing address:
  • Phone: 313-412-6469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: