Provider Demographics
NPI:1659519437
Name:BRANDT, EILEEN ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:ANN
Last Name:BRANDT
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 1:2600 COMPASS RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8001
Mailing Address - Country:US
Mailing Address - Phone:877-787-3430
Mailing Address - Fax:
Practice Address - Street 1:4000 KINGS HWY
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8718
Practice Address - Country:US
Practice Address - Phone:941-255-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056003778225X00000X
FL560121549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist