Provider Demographics
NPI:1902951643
Name:BRAND, M. LOUISE (ITDS)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:LOUISE
Last Name:BRAND
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5032
Mailing Address - Country:US
Mailing Address - Phone:941-722-3582
Mailing Address - Fax:941-729-8322
Practice Address - Street 1:410 10TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5032
Practice Address - Country:US
Practice Address - Phone:941-722-3582
Practice Address - Fax:941-729-8322
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8116784 00Medicaid
FL811678400Medicaid