Provider Demographics
NPI:1376807800
Name:BRAND, NICHOLAS JAMES (OTR)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:BRAND
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3212 EASTOVER RIDGE DR
Mailing Address - Street 2:APT 733
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1466
Mailing Address - Country:US
Mailing Address - Phone:704-296-7465
Mailing Address - Fax:
Practice Address - Street 1:5114 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5852
Practice Address - Country:US
Practice Address - Phone:704-364-2485
Practice Address - Fax:704-364-2485
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC7708225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist