Provider Demographics
NPI:1619736154
Name:RITCHIE, BREANA (OTA/L)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 COPPER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-9314
Mailing Address - Country:US
Mailing Address - Phone:860-367-2169
Mailing Address - Fax:
Practice Address - Street 1:5228 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2456
Practice Address - Country:US
Practice Address - Phone:316-833-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01963224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant