Provider Demographics
NPI:1821379405
Name:JAMES, BRENT EDISON (OTS)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:EDISON
Last Name:JAMES
Suffix:
Gender:M
Credentials:OTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LEAVENWORTH ST
Mailing Address - Street 2:201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7573
Mailing Address - Country:US
Mailing Address - Phone:989-415-0311
Mailing Address - Fax:
Practice Address - Street 1:425 DIVISADERO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2242
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:415-551-1763
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist