Provider Demographics
NPI:1972855807
Name:PRALL, BRANDI RENAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENAY
Last Name:PRALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:RENAY
Other - Last Name:KLIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:314 S MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1708
Mailing Address - Country:US
Mailing Address - Phone:518-437-5528
Mailing Address - Fax:518-437-5573
Practice Address - Street 1:214 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1806
Practice Address - Country:US
Practice Address - Phone:518-935-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017617-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400079692Medicare PIN