Individual
MR. JIMMY DALE BRANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA,L
Contact information
Practice address
313 MAIN, FORDSVILLE, KY 42343
(270) 276-5435
Mailing address
813 BROAD ST, CENTRAL, KY 42330
(270) 754-5280
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A3397
KY
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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