Provider Demographics
NPI:1548616048
Name:ARCHIE, BRANDY (OTR)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:ARCHIE
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 1:1126 QUEENS PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3264
Mailing Address - Country:US
Mailing Address - Phone:816-301-5170
Mailing Address - Fax:816-929-6321
Practice Address - Street 1:1126 QUEENS PL
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3264
Practice Address - Country:US
Practice Address - Phone:816-301-5170
Practice Address - Fax:816-929-6321
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009008897225XE0001X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009008897OtherOT LICENSE #