Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HOSPITAL RD
NEW RICHMOND WI
54017-1449
US

IV. Provider business mailing address

12401 OAK PARK BLVD NE APT 214
BLAINE MN
55434-7324
US

V. Phone/Fax

Practice location:
  • Phone: 715-243-2760
  • 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: