Individual
BRANT MICHAEL WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.T.A.
Contact information
Practice address
1000 E STUART ST, FORT COLLINS, CO 80525-1555
(970) 482-5712
Mailing address
3634 BUTTERNUT DR, LOVELAND, CO 80538-7621
(785) 201-4132
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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