Individual
BRANDYN GORTEMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
605 MENA ST, MENA, AR 71953-3339
(479) 385-5144
Mailing address
1400 VIVIAN ST, MENA, AR 71953-4778
(910) 389-3791
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1458
AR
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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