Provider Demographics
NPI:1316331671
Name:VIZACHERO, BRANDI MARIE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:MARIE
Last Name:VIZACHERO
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 1:2544 CONCORDGREEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3628
Mailing Address - Country:US
Mailing Address - Phone:513-344-3017
Mailing Address - Fax:
Practice Address - Street 1:7100 DEARWESTER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6115
Practice Address - Country:US
Practice Address - Phone:513-745-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.06052224Z00000X
KYBOTOTA00217474224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant