Provider Demographics
NPI:1255991170
Name:HERRICK, BRIANNA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
Last Name:HERRICK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:LYNN
Other - Last Name:DUNKLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1050 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68002-3021
Mailing Address - Country:US
Mailing Address - Phone:402-277-0228
Mailing Address - Fax:
Practice Address - Street 1:600 BROOKSTONE MEADOWS PLZ
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4401
Practice Address - Country:US
Practice Address - Phone:402-289-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1021224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant