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NPI Code Detail

MEDICARE: MR. BRANDON J BLANCHARD OTR

MEDICARE: MR. BRANDON J BLANCHARD OTR
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 Therapist110999TX

General Provider Information

NPI Number : 1619208899
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRANDON J BLANCHARD OTR
Provider Business Mailing Address
First Line : 821 ALLEN ST APT 1016
Second Line :
City : DALLAS
State : TX
Zip : 75204-5890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2428 BAHAMA DR
Second Line :
City : DALLAS
State : TX
Zip : 75211-2121
Country : US
Telephone Number : 214-948-3811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2010
Last Update Date : 01/27/2010

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