Provider Demographics
NPI:1720768732
Name:GIAMALVA, BRILEY DAWN (COTA)
Entity Type:Individual
Prefix:
First Name:BRILEY
Middle Name:DAWN
Last Name:GIAMALVA
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 1:4441 FALL CREEK RD APT 26
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8818
Mailing Address - Country:US
Mailing Address - Phone:816-214-2133
Mailing Address - Fax:
Practice Address - Street 1:10101 LAGRIMA DE ORO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6022
Practice Address - Country:US
Practice Address - Phone:505-298-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2023-0183224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant