Provider Demographics
NPI:1649886532
Name:GAINES, BRIANNE MARIE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:MARIE
Last Name:GAINES
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:MARIE
Other - Last Name:BULLEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:17055 FRANCES ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4655
Mailing Address - Country:US
Mailing Address - Phone:402-280-2200
Mailing Address - Fax:402-280-2210
Practice Address - Street 1:CREIGHTON PEDIATRIC THERAPY
Practice Address - Street 2:17055 FRANCES ST STE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4655
Practice Address - Country:US
Practice Address - Phone:402-780-2200
Practice Address - Fax:402-280-2210
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist