Provider Demographics
NPI:1710241203
Name:CHAMPAGNE, BRITTNEY (OTR)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 ROYAL FRST # B-90
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5045
Mailing Address - Country:US
Mailing Address - Phone:281-358-0577
Mailing Address - Fax:281-358-1520
Practice Address - Street 1:2665 ROYAL FRST # B-90
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5045
Practice Address - Country:US
Practice Address - Phone:281-358-0577
Practice Address - Fax:281-358-1520
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist