Provider Demographics
NPI:1255541991
Name:BRANDON, HEATHER (HEATHER BRANDON, OT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRANDON
Suffix:
Gender:F
Credentials:HEATHER BRANDON, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15131 FRENCH DR N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6301
Mailing Address - Country:US
Mailing Address - Phone:352-281-7857
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9179225X00000X
AZ3372225X00000X
TN3090225X00000X
OR1064567225X00000X
NM2256225X00000X
AK1736225X00000X
VA0119004159225X00000X
FL12092225X00000X
RI01056225X00000X
MN104314225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist