Provider Demographics
NPI:1457778078
Name:LITVIN, BRIENNA E (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRIENNA
Middle Name:E
Last Name:LITVIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRIENNA
Other - Middle Name:E
Other - Last Name:MAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 COUNTY ROAD U
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9587
Mailing Address - Country:US
Mailing Address - Phone:503-504-9458
Mailing Address - Fax:
Practice Address - Street 1:253 PARKSIDE AVE
Practice Address - Street 2:2D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:503-504-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018705-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor