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General NPI Number Information
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NPI Number | 1811272503
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Entity Type | Individual
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Provider Name | BRANDON SCOTT HALE MSOT
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Gender | Male
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 117 MILLARD LN
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-5450
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Country | US
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Telephone | 276-393-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 117 MILLARD LN
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-5450
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Country | US
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Telephone | 276-393-5047
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4323
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119005374
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License Number State | VA
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