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General NPI Number Information
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NPI Number | 1245550920
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Entity Type | Individual
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Provider Name | BRANDI M THORWARTH OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 2420 WILSON AVE
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City | MADISON
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State | IN
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Zip | 47250-2135
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Country | US
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Telephone | 501-802-5479
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Fax |
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Provider Business Mailing Address
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Address Line | 10223 E STATE ROAD 156
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City | VEVAY
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State | IN
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Zip | 47043-2837
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Country | US
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Telephone | 501-802-5479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTR1461
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 31007908A
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License Number State | IN
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