Individual
M COLLETTE BRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 FORD RD, PHILADELPHIA, PA 19131-2833
(215) 877-3110
(215) 871-3110
Mailing address
131 HEDGE LN, COAL TOWNSHIP, PA 17866-7719
(570) 975-9434
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP001163L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932412467
COTA/L
PA
Enumeration date
07/26/2010
Last updated
10/01/2010
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