Provider Demographics
NPI:1073604344
Name:BRUNS, SANDRA SKELLIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SKELLIE
Last Name:BRUNS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SLEEPY HOLLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1533
Mailing Address - Country:US
Mailing Address - Phone:828-273-1334
Mailing Address - Fax:828-298-6930
Practice Address - Street 1:25 SLEEPY HOLLOW DRIVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1533
Practice Address - Country:US
Practice Address - Phone:828-273-1334
Practice Address - Fax:828-298-6930
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22225XP0200X
NC0022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC190695OtherMEDCOST
NC7301925Medicaid
NC1426YOtherBCBSNC