Provider Demographics
NPI:1578935540
Name:HALL, BRANDI (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:HALL
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 1:1623 AUGUSTA SOLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORISKANY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13425-4206
Mailing Address - Country:US
Mailing Address - Phone:315-525-3254
Mailing Address - Fax:
Practice Address - Street 1:3218 ERIE BLVD E
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1204
Practice Address - Country:US
Practice Address - Phone:315-525-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
350075OtherNBCOT CERTIFICATION NUMBER