Provider Demographics
NPI:1447807482
Name:STERN, BRANDIS LOGAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRANDIS
Middle Name:LOGAN
Last Name:STERN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 STEVE ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-5107
Mailing Address - Country:US
Mailing Address - Phone:814-312-8338
Mailing Address - Fax:
Practice Address - Street 1:137 STEVE ST
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-5107
Practice Address - Country:US
Practice Address - Phone:814-312-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist