Provider Demographics
NPI:1518542448
Name:BRICCHI, JESSE LAWRENCE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LAWRENCE
Last Name:BRICCHI
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 60TH DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-6338
Mailing Address - Country:US
Mailing Address - Phone:631-252-6654
Mailing Address - Fax:
Practice Address - Street 1:5215 60TH DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-6338
Practice Address - Country:US
Practice Address - Phone:631-252-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18057224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant