Provider Demographics
NPI:1467834481
Name:SLAUGHTER, BRANDIE
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21703 KINGSLAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2521
Mailing Address - Country:US
Mailing Address - Phone:281-769-1015
Mailing Address - Fax:
Practice Address - Street 1:21703 KINGSLAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2521
Practice Address - Country:US
Practice Address - Phone:281-769-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist