Provider Demographics
NPI:1376233544
Name:MODISETTE, BRITTANY LYNN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNN
Last Name:MODISETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-8126
Mailing Address - Country:US
Mailing Address - Phone:832-297-8320
Mailing Address - Fax:
Practice Address - Street 1:602 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-8126
Practice Address - Country:US
Practice Address - Phone:832-297-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
216296224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant