Provider Demographics
NPI:1154756872
Name:LOCKARD, BRANDY MICHELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:LOCKARD
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 1:5223 TROPICANA DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8159
Mailing Address - Country:US
Mailing Address - Phone:865-680-9795
Mailing Address - Fax:
Practice Address - Street 1:2900 LAKE BROOK BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1135
Practice Address - Country:US
Practice Address - Phone:865-558-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4696225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology