Healthcare Provider Details

I. General information

NPI: 1376250357
Provider Name (Legal Business Name): BRANDI HOTOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CORPORATE SQUARE DRIVE
SAINT LOUIS MO
63132
US

IV. Provider business mailing address

12430 TESSON FERRY RD # 206
SAINT LOUIS MO
63128-2702
US

V. Phone/Fax

Practice location:
  • Phone: 512-660-7303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65591
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2022007514
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: