Individual
MRS. BRANDI HAVARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
100 E FERGUSON ST, TYLER, TX 75702-5759
(903) 509-2040
Mailing address
4116 CONCORD PL, TEXARKANA, TX 75503-0995
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211153
TX
224Z00000X
Occupational Therapy Assistant
OT-A584
AR
Other
Enumeration date
04/26/2010
Last updated
03/17/2018
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