Provider Demographics
NPI:1124739933
Name:HICKMAN, BRANDI ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:ELIZABETH
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 CIRCULAR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4202
Mailing Address - Country:US
Mailing Address - Phone:419-309-0371
Mailing Address - Fax:
Practice Address - Street 1:5069 OTTERBEIN WAY
Practice Address - Street 2:
Practice Address - City:MONCLOVA
Practice Address - State:OH
Practice Address - Zip Code:43542-8500
Practice Address - Country:US
Practice Address - Phone:419-878-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA002754224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant