MEDICARE: BRITTANY RAISANEN OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	20764	FL

General Provider Information

NPI Number	:	1316573645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY RAISANEN OTRL

Provider Business Mailing Address
First Line	:	604 DIVISION ST
Second Line	:
City	:	HURLEY
State	:	WI
Zip	:	54534-1230
Country	:	US
Telephone Number	:	906-364-1409
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 ARLINGTON CIR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34113-3205
Country	:	US
Telephone Number	:	866-986-9690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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