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NPI Code Detail

MEDICARE: MS. BRANDYE ELIZABETH PETERSON OTR/L

MEDICARE: MS. BRANDYE ELIZABETH PETERSON OTR/L
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
1225X00000XOccupational Therapist5350NC

General Provider Information

NPI Number : 1437304540
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRANDYE ELIZABETH PETERSON OTR/L
Provider Business Mailing Address
First Line : 508 WOODLAWN AVE
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1753
Country : US
Telephone Number : 336-681-3869
Fax Number :
Provider Business Practice Location Address
First Line : 109 PENNY RD
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-2500
Country : US
Telephone Number : 336-821-6592
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2008
Last Update Date : 11/18/2008

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