Provider Demographics
NPI:1295377828
Name:BRAND, KRISCHELL SCARLETH (MA73471)
Entity type:Individual
Prefix:
First Name:KRISCHELL
Middle Name:SCARLETH
Last Name:BRAND
Suffix:
Gender:F
Credentials:MA73471
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4336
Mailing Address - Country:US
Mailing Address - Phone:863-668-1397
Mailing Address - Fax:
Practice Address - Street 1:2791 LAKE ALFRED RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1432
Practice Address - Country:US
Practice Address - Phone:863-291-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73471225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist