Provider Demographics
NPI:1649853599
Name:WINTERS, BRANDIE MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MARIE
Last Name:WINTERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:MARIE
Other - Last Name:HOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-1241
Mailing Address - Country:US
Mailing Address - Phone:618-531-8807
Mailing Address - Fax:
Practice Address - Street 1:7358 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1710
Practice Address - Country:US
Practice Address - Phone:877-522-4438
Practice Address - Fax:855-673-0845
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005179224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant