Provider Demographics
NPI:1790911980
Name:BRAND, JOSETTE IOLA (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:IOLA
Last Name:BRAND
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11463 196TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2715
Mailing Address - Country:US
Mailing Address - Phone:347-258-0118
Mailing Address - Fax:
Practice Address - Street 1:11463 196TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2715
Practice Address - Country:US
Practice Address - Phone:347-258-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015046-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist