Provider Demographics
NPI:1891446779
Name:PETTY-CARTER, BRIANA ARIAH (COTA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:ARIAH
Last Name:PETTY-CARTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 HEGIRA ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7788
Mailing Address - Country:US
Mailing Address - Phone:321-505-1606
Mailing Address - Fax:
Practice Address - Street 1:1306 HEGIRA ST NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7788
Practice Address - Country:US
Practice Address - Phone:321-505-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA17145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant