Provider Demographics
NPI:1992469811
Name:BRANDBERG, MEGAN MANESS
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MANESS
Last Name:BRANDBERG
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 1:201 NC 54 APT 721
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1652
Mailing Address - Country:US
Mailing Address - Phone:336-564-5801
Mailing Address - Fax:
Practice Address - Street 1:3624 SHANNON RD STE 104
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3772
Practice Address - Country:US
Practice Address - Phone:919-493-7002
Practice Address - Fax:919-403-1407
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14454225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist