Provider Demographics
NPI:1750926622
Name:NIELSEN, BRIANNA HATCHELL (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:HATCHELL
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:NICOLE
Other - Last Name:HATCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:4 PARK AVE APT 10N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5309
Mailing Address - Country:US
Mailing Address - Phone:704-258-2662
Mailing Address - Fax:
Practice Address - Street 1:150 W 92ND ST APT BB
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7556
Practice Address - Country:US
Practice Address - Phone:212-595-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024163-01225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics