Basic Information
| Provider Information | |||||||||
| NPI: | 1417538075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | BRANDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 BOYD BLVD | ||||||||
| Address2: | |||||||||
| City: | GALION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448332430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5673072577 | ||||||||
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| Practice Location | |||||||||
| Address1: | 841 W MARION RD | ||||||||
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| City: | MOUNT GILEAD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433381094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199472015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2021 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 007095 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.