Provider Demographics
NPI:1902955743
Name:WILSON REED, BRANDY (OTR)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:WILSON REED
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:S
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:70 MOORE CIR
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-9476
Mailing Address - Country:US
Mailing Address - Phone:501-208-2828
Mailing Address - Fax:
Practice Address - Street 1:3450 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5508
Practice Address - Country:US
Practice Address - Phone:870-534-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1628225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152369721Medicaid
AROTR1628OtherOT LICENSURE