Healthcare Provider Details

I. General information

NPI: 1639093768
Provider Name (Legal Business Name): BREIGH ANNA HAGGARTY MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2547 E RIVERSIDE DR
ONTARIO CA
91761-7363
US

IV. Provider business mailing address

27772 PEBBLE BCH
MISSION VIEJO CA
92692-1548
US

V. Phone/Fax

Practice location:
  • Phone: 909-923-6017
  • Fax:
Mailing address:
  • Phone: 563-343-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: