Provider Demographics
NPI:1699004937
Name:SPAULDING, BRANDI MASHELL (MS, OTR)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MASHELL
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-8004
Mailing Address - Country:US
Mailing Address - Phone:317-445-2603
Mailing Address - Fax:
Practice Address - Street 1:2055 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3158
Practice Address - Country:US
Practice Address - Phone:765-342-3305
Practice Address - Fax:765-342-9575
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004600A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31004600AOtherINDIANA PROFESSIONAL LICENSE