Provider Demographics
NPI:1720338270
Name:BRANDRIET, RACHEL KAY (COTA)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:KAY
Last Name:BRANDRIET
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17356 447TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7629
Mailing Address - Country:US
Mailing Address - Phone:605-237-0059
Mailing Address - Fax:
Practice Address - Street 1:17356 447TH AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-7629
Practice Address - Country:US
Practice Address - Phone:605-237-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant