Provider Demographics
NPI:1134399405
Name:BRANDT, LASHAWNA APRIL (COTA)
Entity type:Individual
Prefix:MS
First Name:LASHAWNA
Middle Name:APRIL
Last Name:BRANDT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-3708
Mailing Address - Country:US
Mailing Address - Phone:940-781-0265
Mailing Address - Fax:
Practice Address - Street 1:100 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6927
Practice Address - Country:US
Practice Address - Phone:940-766-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209365OtherCOTA