Provider Demographics
NPI:1316563760
Name:COOPER, BRIANNA GIBBS (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:GIBBS
Last Name:COOPER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:BOYLON
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0778
Mailing Address - Country:US
Mailing Address - Phone:907-766-2101
Mailing Address - Fax:
Practice Address - Street 1:69 BEACH ROAD
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-9982
Practice Address - Country:US
Practice Address - Phone:907-766-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK162724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
438556OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY