Provider Demographics
NPI:1306573332
Name:BRANDSGARD, LILLIAN RACHEL
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:RACHEL
Last Name:BRANDSGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LILLIAN
Other - Middle Name:RACHEL
Other - Last Name:BRANDSGARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:2061 SALERNO AVE
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-1338
Mailing Address - Country:US
Mailing Address - Phone:909-462-8147
Mailing Address - Fax:
Practice Address - Street 1:1350 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8629
Practice Address - Country:US
Practice Address - Phone:909-925-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4298224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty