Provider Demographics
NPI:1053935585
Name:BRANNER, ANNALEE AMELIA (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANNALEE
Middle Name:AMELIA
Last Name:BRANNER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ANNALEE
Other - Middle Name:AMELIA
Other - Last Name:COPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:4213 BUNKER HILL RD APT 3215
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4501
Mailing Address - Country:US
Mailing Address - Phone:417-540-5295
Mailing Address - Fax:
Practice Address - Street 1:1101 WINDBELL ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2177
Practice Address - Country:US
Practice Address - Phone:972-288-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215761224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant