Provider Demographics
NPI:1750743803
Name:SMITH, BRIEANN (COTA)
Entity type:Individual
Prefix:
First Name:BRIEANN
Middle Name:
Last Name:SMITH
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 1:14101 BAY VISTA DR
Mailing Address - Street 2:APT 201
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4817
Mailing Address - Country:US
Mailing Address - Phone:401-649-8989
Mailing Address - Fax:
Practice Address - Street 1:14101 BAY VISTA DR
Practice Address - Street 2:APT 201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4817
Practice Address - Country:US
Practice Address - Phone:401-649-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000428224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant