MEDICARE: MRS. BRIONNA JANINE MITCHELL 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	OT-2133	NV

General Provider Information

NPI Number	:	1962158626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIONNA JANINE MITCHELL OTR/L

Provider Business Mailing Address
First Line	:	3250 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 SOUTH FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117
Country	:	US
Telephone Number	:	702-553-1429
Fax Number	:

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

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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