Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31000462A | IN |
N | 225XH1200X | Occupational Therapist - Hand | 31000462A | IN |
NPI | 1184728438 |
---|---|
Provider Name | Gail Ann Brandenburg |
First Address | Indianapolis, IN 46260 |
Second Address | Indianapolis, IN 46260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 24/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000179449 | ANTHEM HEALTH PLAN (01) | |
062110021 | MEDICARE PTAN (01) | IN |
200037100 | (05) | IN |
P00294220 | RR MEDICARE (01) | IN |