Provider Demographics
NPI:1518221639
Name:BRANDENBURG, ERIN (OTR)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BRANDENBURG
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 1:1424 NW ELGIN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3032
Mailing Address - Country:US
Mailing Address - Phone:541-581-0530
Mailing Address - Fax:
Practice Address - Street 1:1424 NW ELGIN AVE # 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3032
Practice Address - Country:US
Practice Address - Phone:541-581-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR298218225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR47-4409407OtherEIN