Healthcare Provider Details

I. General information

NPI: 1467883223
Provider Name (Legal Business Name): BRITTANY NICOLE WEST OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 EAGLE BLUFF CIR STE 110
MEDINA MN
55340-5002
US

IV. Provider business mailing address

2900 EAGLE BLUFF CIR STE 110
MEDINA MN
55340-5002
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-9359
  • Fax: 612-238-8679
Mailing address:
  • Phone: 262-470-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104578
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: