Provider Demographics
NPI:1649939554
Name:BRANDELL, ALEX (OTD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BRANDELL
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ALEX
Other - Last Name:BRANDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1123 CHATSWORTH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1002
Mailing Address - Country:US
Mailing Address - Phone:715-297-2572
Mailing Address - Fax:
Practice Address - Street 1:500 HARVARD ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0363
Practice Address - Country:US
Practice Address - Phone:612-273-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106699225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation