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General NPI Number Information
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NPI Number | 1811553472
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Entity Type | Individual
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Provider Name | BRANDON ANTHONY BLACKWELL OTR/L
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Gender | Male
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Dates
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Enumeration Date | 05/18/2019
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Last Update Date | 05/18/2019
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Provider Practice Location Address
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Address Line | 1900 L ST NW STE 607
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City | WASHINGTON
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State | DC
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Zip | 20036-5047
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Country | US
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Telephone | 202-528-7223
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Fax |
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Provider Business Mailing Address
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Address Line | 14700 4TH ST APT 216
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City | LAUREL
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State | MD
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Zip | 20707-3964
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Country | US
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Telephone | 216-409-1045
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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 | 08448
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License Number State | MD
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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 | 0T010001475
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License Number State | DC
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