1245550920 NPI number — BRANDI M THORWARTH OTR/L

Table of content: BRANDI M THORWARTH OTR/L (NPI 1245550920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245550920 NPI number — BRANDI M THORWARTH OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORWARTH
Provider First Name:
BRANDI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245550920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10223 E STATE ROAD 156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VEVAY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47043-2837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-802-5479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2420 WILSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47250-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-802-5479
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OTR1461 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 31007908A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136478721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com