Provider Demographics
NPI:1407045909
Name:STIFFLER, BRANDY (OTR)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:STIFFLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2461 FAIR OAKS LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9734
Mailing Address - Country:US
Mailing Address - Phone:469-774-0184
Mailing Address - Fax:
Practice Address - Street 1:4601 MEDICAL CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1771
Practice Address - Country:US
Practice Address - Phone:469-774-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist