Provider Demographics
NPI:1700086964
Name:ROSENBERG, BRANDON (OTR L)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E DEBBIE DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85240-4003
Mailing Address - Country:US
Mailing Address - Phone:269-352-4365
Mailing Address - Fax:
Practice Address - Street 1:1301 E DEBBIE DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85240-4003
Practice Address - Country:US
Practice Address - Phone:269-352-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist