MEDICARE: JOANNE BRANKIN INC

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	225X00000X	Occupational Therapist	OT 6825	CA

General Provider Information

NPI Number	:	1073865010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNE BRANKIN INC

Provider Business Mailing Address
First Line	:	6724 HILLPARK DR
Second Line	:	#304
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-2169
Country	:	US
Telephone Number	:	310-980-6675
Fax Number	:

Provider Business Practice Location Address
First Line	:	6724 HILLPARK DR
Second Line	:	#304
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-2169
Country	:	US
Telephone Number	:	310-980-6675
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOANNE BRANKIN
Credential	:	OTR
Telephone Number	:	310-980-6675

Provider Enumeration Date	:	10/14/2012
Last Update Date	:	10/14/2012

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