Provider Demographics
NPI:1023159787
Name:BRANTNER, CHARLENE MARIE (OT)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARIE
Last Name:BRANTNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-1126
Mailing Address - Country:US
Mailing Address - Phone:814-832-4631
Mailing Address - Fax:
Practice Address - Street 1:929 14TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-3028
Practice Address - Country:US
Practice Address - Phone:814-643-0337
Practice Address - Fax:814-643-9231
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007390L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01898659Medicaid