Provider Demographics
NPI:1336610203
Name:VANNATTA, BRITTA L (OTR)
Entity Type:Individual
Prefix:
First Name:BRITTA
Middle Name:L
Last Name:VANNATTA
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 1:3826 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-1610
Mailing Address - Country:US
Mailing Address - Phone:292-903-9480
Mailing Address - Fax:
Practice Address - Street 1:3826 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-1610
Practice Address - Country:US
Practice Address - Phone:262-903-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1336610203225X00000X
WI6308-26225X00000X
MN105736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist