Provider Demographics
NPI:1316573645
Name:RAISANEN, BRITTANY (OTRL)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:RAISANEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54534-1230
Mailing Address - Country:US
Mailing Address - Phone:906-364-1409
Mailing Address - Fax:
Practice Address - Street 1:8000 ARLINGTON CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-3205
Practice Address - Country:US
Practice Address - Phone:866-986-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20764225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist