Provider Demographics
NPI:1609044908
Name:ROWE, BRANDON (COTA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 BRIDGEPT WAY SW
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PMB 294 10011 BRIDGEPT WAY SW
Practice Address - Street 2:SUITE 1500
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2332
Practice Address - Country:US
Practice Address - Phone:253-720-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist