MEDICARE: OLIVIA ANN BRISCOE OTR/L

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	OT012141	OH

General Provider Information

NPI Number	:	1871396689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA ANN BRISCOE OTR/L

Provider Business Mailing Address
First Line	:	1284 S YORKSHIRE DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4267
Country	:	US
Telephone Number	:	330-329-6718
Fax Number	:

Provider Business Practice Location Address
First Line	:	7123 PEARL RD STE AND103
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4975
Country	:	US
Telephone Number	:	440-202-1706
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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