Provider Demographics
NPI:1487431599
Name:VETTERKIND, BRANDON JOHN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOHN
Last Name:VETTERKIND
Suffix:
Gender:M
Credentials:MS, 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:E6410 ELM RD
Mailing Address - Street 2:
Mailing Address - City:STRUM
Mailing Address - State:WI
Mailing Address - Zip Code:54770-9644
Mailing Address - Country:US
Mailing Address - Phone:715-579-0938
Mailing Address - Fax:
Practice Address - Street 1:E6410 ELM RD
Practice Address - Street 2:
Practice Address - City:STRUM
Practice Address - State:WI
Practice Address - Zip Code:54770-9644
Practice Address - Country:US
Practice Address - Phone:715-579-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT24165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist