Provider Demographics
NPI:1306374988
Name:DYE, BRANDI (COTA, OTR)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:DYE
Suffix:
Gender:F
Credentials:COTA, OTR
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA, OTR
Mailing Address - Street 1:236 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3663
Mailing Address - Country:US
Mailing Address - Phone:608-289-8207
Mailing Address - Fax:
Practice Address - Street 1:303 W COURT ST STE 101
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3865
Practice Address - Country:US
Practice Address - Phone:608-563-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
IL056013976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist