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Individual
GAIL ANN BRANDENBURG
Active
Individual
GAIL ANN BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31000462A
IN
225XH1200X
Hand Occupational Therapist
31000462A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000179449
ANTHEM HEALTH PLAN
—
01
—
062110021
MEDICARE PTAN
IN
05
—
200037100
—
IN
01
—
P00294220
RR MEDICARE
IN
Enumeration date
09/08/2006
Last updated
09/24/2013
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