Provider Demographics
NPI:1609132240
Name:KOMASINSKI, BRITTANY ANN (DT)
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:ANN
Last Name:KOMASINSKI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 OREGON LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5282
Mailing Address - Country:US
Mailing Address - Phone:219-730-2961
Mailing Address - Fax:866-463-2060
Practice Address - Street 1:5201 FOUNTAIN DR
Practice Address - Street 2:STE D
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5324
Practice Address - Country:US
Practice Address - Phone:219-796-9335
Practice Address - Fax:866-463-2060
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist