Healthcare Provider Details

I. General information

NPI: 1689134397
Provider Name (Legal Business Name): BRIANA MARIE OBRIEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 DETROIT AVE STE 136
CLEVELAND OH
44113-2701
US

IV. Provider business mailing address

9066 MCKINLEY DR
NORTHFIELD OH
44067-1219
US

V. Phone/Fax

Practice location:
  • Phone: 330-719-7605
  • Fax:
Mailing address:
  • Phone: 330-719-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: