Provider Demographics
NPI:1457423394
Name:BRANT, PAMELA (MA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR# 2 BOX 172
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847
Mailing Address - Country:US
Mailing Address - Phone:607-729-0044
Mailing Address - Fax:607-729-9994
Practice Address - Street 1:693 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-7200
Practice Address - Country:US
Practice Address - Phone:570-465-2027
Practice Address - Fax:570-465-2028
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006833225XH1200X
PAOC005531L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638439Medicaid
NY5041880001Medicare NSC
NYRA2656Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
NY02638439Medicaid