Individual
BRANDON DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
509 POPLAR FORK ROAD, HURRICANE, WV 25526
(304) 757-7826
Mailing address
181 FOUNTAIN PL, HUNTINGTON, WV 25701-5203
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1762
WV
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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