Healthcare Provider Details

I. General information

NPI: 1760150668
Provider Name (Legal Business Name): BRIANNA BRUNNER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA KOWALSKY OTR/L

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 US HIGHWAY 12
BALDWIN WI
54002-3202
US

IV. Provider business mailing address

310 RUSSELLS CT
WOODVILLE WI
54028-9510
US

V. Phone/Fax

Practice location:
  • Phone: 715-684-3334
  • Fax:
Mailing address:
  • Phone: 262-930-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106616
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7071-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: