Provider Demographics
NPI:1609017920
Name:RUSSELL, BRANDYN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRANDYN
Middle Name:MARIE
Last Name:RUSSELL
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 1:21004 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-2662
Mailing Address - Country:US
Mailing Address - Phone:913-839-0317
Mailing Address - Fax:
Practice Address - Street 1:6400 GLENWOOD ST
Practice Address - Street 2:205
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4028
Practice Address - Country:US
Practice Address - Phone:913-432-2900
Practice Address - Fax:913-432-2901
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02346225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics