Provider Demographics
NPI:1417790411
Name:BRANDENBURG, ELIZABETH
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WASHINGTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2131
Mailing Address - Country:US
Mailing Address - Phone:937-601-2543
Mailing Address - Fax:
Practice Address - Street 1:3218 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3637
Practice Address - Country:US
Practice Address - Phone:937-426-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012865225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist