Provider Demographics
NPI:1194274043
Name:HENDERSON, BRANDON (OTD, OTR/L, CHT)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:OTD, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 BELLAROSA CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1467
Mailing Address - Country:US
Mailing Address - Phone:240-418-1715
Mailing Address - Fax:
Practice Address - Street 1:2923 BELLAROSA CIR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1467
Practice Address - Country:US
Practice Address - Phone:240-418-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist