MEDICARE: BRITTANY VANDERWILT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	216481	TX

General Provider Information

NPI Number	:	1073280061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY VANDERWILT

Provider Business Mailing Address
First Line	:	5212 SINCLAIR AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-6301
Country	:	US
Telephone Number	:	903-272-5758
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 SINCLAIR AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-6301
Country	:	US
Telephone Number	:	432-689-9898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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Directions to “ BRITTANY VANDERWILT ” Practice Location

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