Provider Demographics
NPI:1356878078
Name:WARREN, BRITTNEY (COTA)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:WARREN
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 1:29402 TOURNAMENT
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4735
Mailing Address - Country:US
Mailing Address - Phone:909-446-5836
Mailing Address - Fax:
Practice Address - Street 1:29402 TOURNAMENT
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4735
Practice Address - Country:US
Practice Address - Phone:909-446-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2300224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant