Individual
BRANDON JASON BAUMGARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSOTR/L
Contact information
Practice address
165 PEPPERS FERRY RD, WYTHEVILLE, VA 24382-2070
(276) 223-5400
(276) 223-5454
Mailing address
165 PEPPERS FERRY RD, WYTHEVILLE, VA 24382-2070
(276) 223-5400
(276) 223-5454
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005285
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119005285
VIRGINIA
VA
Enumeration date
03/26/2013
Last updated
03/29/2013
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