Provider Demographics
NPI:1114535515
Name:BRIGGLE, CORY RAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:RAY
Last Name:BRIGGLE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:TX
Mailing Address - Zip Code:75462-6160
Mailing Address - Country:US
Mailing Address - Phone:940-206-1589
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11813055-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist