Provider Demographics
NPI:1114204344
Name:LICHTENWALNER, BRANDI ALYSSA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ALYSSA
Last Name:LICHTENWALNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SPARROW WAY
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031
Mailing Address - Country:US
Mailing Address - Phone:610-554-4742
Mailing Address - Fax:
Practice Address - Street 1:1030 SPARROW WAY
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1662
Practice Address - Country:US
Practice Address - Phone:610-387-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006330224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant