Provider Demographics
NPI:1710016696
Name:BRANDT, MARILYN E (OTR, L)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:E
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 1:375 LAGUNA HONDA BLVD
Mailing Address - Street 2:LAGUNA HONDA HOSPITAL, OCCUPATIONAL THERAPY DEPT.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1411
Mailing Address - Country:US
Mailing Address - Phone:415-759-4521
Mailing Address - Fax:415-759-6317
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:LAGUNA HONDA HOSPITAL, OCCUPATIONAL THERAPY DEPT.
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1411
Practice Address - Country:US
Practice Address - Phone:415-759-4521
Practice Address - Fax:415-759-6317
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 188225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 188OtherCA BOARD OF OT