Provider Demographics
NPI:1821277245
Name:BRANDAU, JEANINE SMITH (OTR, CLT)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:SMITH
Last Name:BRANDAU
Suffix:
Gender:F
Credentials:OTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 CHANCE CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8719
Mailing Address - Country:US
Mailing Address - Phone:713-412-3315
Mailing Address - Fax:281-692-1833
Practice Address - Street 1:3006 CHANCE CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8719
Practice Address - Country:US
Practice Address - Phone:713-412-3315
Practice Address - Fax:281-692-1833
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist