Provider Demographics
NPI:1679108005
Name:COE, BRANDY
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:COE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:HULTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3161 E PALMER WASILLA HWY STE 1C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7271
Mailing Address - Country:US
Mailing Address - Phone:907-357-1818
Mailing Address - Fax:907-357-1814
Practice Address - Street 1:3161 E PALMER WASILLA HWY STE 1C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7271
Practice Address - Country:US
Practice Address - Phone:907-357-1818
Practice Address - Fax:907-357-1814
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist