Healthcare Provider Details

I. General information

NPI: 1679210397
Provider Name (Legal Business Name): BRANDI LYNNE HOVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. BRANDI LYNNE CAUDILL

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/14/2022
Certification Date: 05/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W JEFFERSON ST APT 11
EVART MI
49631-9471
US

IV. Provider business mailing address

711 W JEFFERSON ST APT 13
EVART MI
49631-9472
US

V. Phone/Fax

Practice location:
  • Phone: 231-468-5446
  • Fax:
Mailing address:
  • Phone: 231-253-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: