Provider Demographics
NPI:1952848202
Name:BRAR, SUPREET
Entity Type:Individual
Prefix:
First Name:SUPREET
Middle Name:
Last Name:BRAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 N JOSEY LN STE 130
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4662
Mailing Address - Country:US
Mailing Address - Phone:469-212-8888
Mailing Address - Fax:469-212-8899
Practice Address - Street 1:4541 N JOSEY LN STE 130
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4662
Practice Address - Country:US
Practice Address - Phone:469-212-8888
Practice Address - Fax:469-212-8899
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist