Provider Demographics
NPI:1871258194
Name:KRAENOW, BRIANA ROSE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:ROSE
Last Name:KRAENOW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E G ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6222
Mailing Address - Country:US
Mailing Address - Phone:308-216-1335
Mailing Address - Fax:
Practice Address - Street 1:4000 W PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0305
Practice Address - Country:US
Practice Address - Phone:308-532-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1121224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant