Healthcare Provider Details

I. General information

NPI: 1629914759
Provider Name (Legal Business Name): BRANDI M WAMMES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W STATE ST STE 2
FREMONT OH
43420-2530
US

IV. Provider business mailing address

1838 PORT CLINTON RD
FREMONT OH
43420-1314
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-6709
  • Fax:
Mailing address:
  • Phone: 419-680-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: