Provider Demographics
NPI:1710135843
Name:MACNAUGHTON, BRIAN WILLIAM (OT/L)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:MACNAUGHTON
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3682 EAST CENTER STREET
Mailing Address - Street 2:POST OFFICE BOX 418
Mailing Address - City:NORTH KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44068
Mailing Address - Country:US
Mailing Address - Phone:440-224-1909
Mailing Address - Fax:
Practice Address - Street 1:3682 E CENTER ST
Practice Address - Street 2:POST OFFICE BOX 418
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-3330
Practice Address - Country:US
Practice Address - Phone:440-224-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-5091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist