Provider Demographics
NPI:1558460444
Name:GREEN, BRANDI SUZANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:SUZANNE
Last Name:GREEN
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 1:117 BRANCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-2130
Mailing Address - Country:US
Mailing Address - Phone:256-546-2799
Mailing Address - Fax:256-546-2720
Practice Address - Street 1:401A BAY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5107
Practice Address - Country:US
Practice Address - Phone:256-546-2799
Practice Address - Fax:256-546-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1673225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL1143Medicare UPIN