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General NPI Number Information
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NPI Number | 1871823674
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Entity Type | Individual
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Provider Name | KELLIE BRANNON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 5920 SW 68TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3524
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Country | US
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Telephone | 305-270-9026
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Fax |
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Provider Business Mailing Address
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Address Line | 18420 SW 79TH CT
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City | CUTLER BAY
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State | FL
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Zip | 33157-7446
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Country | US
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Telephone | 305-232-1218
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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 | OT3867
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License Number State | FL
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