Provider Demographics
NPI:1740040674
Name:BORG, BRANDY SNOW (COTA/L)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:SNOW
Last Name:BORG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 COLONIAL ESTATES CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-1940
Mailing Address - Country:US
Mailing Address - Phone:804-564-6507
Mailing Address - Fax:
Practice Address - Street 1:4840 WALLER RD STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2912
Practice Address - Country:US
Practice Address - Phone:804-839-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002552224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant