Active NPI
Brandon Clinton Allen
- Recreation Therapist
- Detroit, MI
National Provider Identifier
1437396819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 432065203
- Practice address
- 12091 Sorrento St
Detroit, MI 48227-3751 - Phone
- (313) 397-1884
- NPI assigned
- Jan 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 432065203 | MI | Primary |
Addresses
Primary practice location
12091 Sorrento St
Detroit, MI 48227-3751
Mailing address
PO Box 2172
Southfield, MI 48037-2172
Phone (313) 685-7811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 432065203 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1437396819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2172",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480372172",
"telephone_number": "313-685-7811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12091 SORRENTO ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482273751",
"telephone_number": "313-397-1884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "BRANDON",
"middle_name": "CLINTON",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-07",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MI",
"license": "432065203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.