Provider Demographics
NPI:1437304540
Name:PETERSON, BRANDYE ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:BRANDYE
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
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 1:508 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1753
Mailing Address - Country:US
Mailing Address - Phone:336-681-3869
Mailing Address - Fax:
Practice Address - Street 1:109 PENNY RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-2500
Practice Address - Country:US
Practice Address - Phone:336-821-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist