Individual
BRANT MICHAEL WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.T.A.
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0000407
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000407
STATE OF COLORADO BOARD OF HEALING ARTS
CO
Enumeration date
09/07/2014
Last updated
09/07/2014
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