Provider Demographics
NPI:1124753678
Name:BRANNON, AUSTIN CONNOR (MOT, LOTR)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CONNOR
Last Name:BRANNON
Suffix:
Gender:M
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 VERSAILLES BUSINESS PKWY APT 513
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6180
Mailing Address - Country:US
Mailing Address - Phone:318-423-9563
Mailing Address - Fax:
Practice Address - Street 1:67252 INDUSTRY LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8704
Practice Address - Country:US
Practice Address - Phone:985-801-6265
Practice Address - Fax:985-801-6213
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA331744225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand