Provider Demographics
NPI:1033234505
Name:BRANDT, LISBA PROBECK (OTRL, CHT)
Entity Type:Individual
Prefix:MRS
First Name:LISBA
Middle Name:PROBECK
Last Name:BRANDT
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3206
Mailing Address - Country:US
Mailing Address - Phone:650-356-0371
Mailing Address - Fax:
Practice Address - Street 1:14 41ST AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-5106
Practice Address - Country:US
Practice Address - Phone:650-522-8850
Practice Address - Fax:650-522-8853
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5706225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand