Provider Demographics
NPI:1679869424
Name:BRANDT, BRYANNE (MSORT/L)
Entity Type:Individual
Prefix:
First Name:BRYANNE
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MSORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FENTON WOOD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5718
Mailing Address - Country:US
Mailing Address - Phone:404-805-7537
Mailing Address - Fax:
Practice Address - Street 1:235 OLD WATERFORD RD NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2117
Practice Address - Country:US
Practice Address - Phone:703-771-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2140225X00000X
RIOT01223225X00000X
GAOT006143225X00000X
OHOT.007925225X00000X
MD08446225X00000X
NY017042-01225X00000X
NC9528225X00000X
OR258571225X00000X
TX115853225X00000X
PAOC012198225X00000X
VA0119007714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist