Provider Demographics
NPI:1669055331
Name:LILJEBLAD, BRANDY ROSE
Entity type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:ROSE
Last Name:LILJEBLAD
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 1:8 LILAC CIRCLE
Mailing Address - Street 2:UNIT B
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450
Mailing Address - Country:US
Mailing Address - Phone:617-461-4923
Mailing Address - Fax:
Practice Address - Street 1:8 LILAC CIRCLE
Practice Address - Street 2:UNIT B
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450
Practice Address - Country:US
Practice Address - Phone:617-461-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist