Provider Demographics
NPI:1033583216
Name:ROBERSON, BRANDON (MS,OTR)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MS,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9460
Mailing Address - Country:US
Mailing Address - Phone:509-270-3737
Mailing Address - Fax:
Practice Address - Street 1:14505 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9460
Practice Address - Country:US
Practice Address - Phone:509-270-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60608348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist