Provider Demographics
NPI:1598800872
Name:HALL, BRIANNA LOMBA (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:LOMBA
Last Name:HALL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:BRIANNA
Other - Last Name:LOMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 PARKMOOR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2422
Mailing Address - Country:US
Mailing Address - Phone:408-241-9911
Mailing Address - Fax:408-241-7788
Practice Address - Street 1:1520 PARKMOOR AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2422
Practice Address - Country:US
Practice Address - Phone:408-241-9911
Practice Address - Fax:408-241-7788
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT9199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist