Provider Demographics
NPI:1811272503
Name:HALE, BRANDON SCOTT (MSOT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SCOTT
Last Name:HALE
Suffix:
Gender:M
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MILLARD LN
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5450
Mailing Address - Country:US
Mailing Address - Phone:276-393-5047
Mailing Address - Fax:
Practice Address - Street 1:117 MILLARD LN
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-5450
Practice Address - Country:US
Practice Address - Phone:276-393-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4323225X00000X
VA0119005374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist