Provider Demographics
NPI:1649268988
Name:BERMUDEZ, BRANT A (OTR/L,CHT)
Entity type:Individual
Prefix:MR
First Name:BRANT
Middle Name:A
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:SUITE 6600
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4915
Mailing Address - Country:US
Mailing Address - Phone:505-724-4300
Mailing Address - Fax:505-724-4384
Practice Address - Street 1:8220 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2105
Practice Address - Country:US
Practice Address - Phone:505-724-4300
Practice Address - Fax:505-724-4384
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2597225XH1200X
NM2411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71781722Medicaid
AZ889884Medicaid
AZ889884Medicaid
NM71781722Medicaid
AZ104887Medicare ID - Type Unspecified