Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 3984 | AL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 3984 | AL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3984 | AL |
NPI | 1649767914 |
---|---|
Provider Name | William Keith Brannen |
First Address | Wetumpka, AL 36092-3525 |
Second Address | Montgomery, AL 36116-1143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2018 |
Last Update Date | 22/04/2018 |