MEDICARE: BRANDI ELSIE MARIE BOTHE

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	225400000X	Rehabilitation Practitioner
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1871454751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI ELSIE MARIE BOTHE

Provider Business Mailing Address
First Line	:	1485 TUNISIA RD
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-7427
Country	:	US
Telephone Number	:	831-253-0072
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 TUNISIA RD
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-7427
Country	:	US
Telephone Number	:	831-253-0072
Fax Number	:

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

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	03/11/2026

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Directions to “ BRANDI ELSIE MARIE BOTHE ” Practice Location

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