Provider Demographics
NPI:1205019312
Name:HARPER, BRANDY DENETTE (DT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:DENETTE
Last Name:HARPER
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5424
Mailing Address - Country:US
Mailing Address - Phone:217-431-3888
Mailing Address - Fax:217-431-3888
Practice Address - Street 1:101 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5424
Practice Address - Country:US
Practice Address - Phone:217-431-3888
Practice Address - Fax:217-431-3888
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBR69550299P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist