Provider Demographics
NPI:1497907984
Name:BRAZIEL, ANDREA LEIGH (OTR)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:BRAZIEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 HAMILTON DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2127
Mailing Address - Country:US
Mailing Address - Phone:940-591-7071
Mailing Address - Fax:
Practice Address - Street 1:2126 HAMILTON DR
Practice Address - Street 2:SUITE 230
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-2127
Practice Address - Country:US
Practice Address - Phone:940-591-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist