Individual
MR. JOHN BLAINE BRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L CHT
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-2690
Mailing address
2300 N EDWARD ST, DECATUR, IL 62526-4163
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
225XH1200X
Hand Occupational Therapist
Primary
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056003998
—
IL
Enumeration date
07/03/2012
Last updated
07/03/2012
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