Provider Demographics
NPI:1831559830
Name:JOHN, BRIANNA CHELSEA (OTR)
Entity type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:CHELSEA
Last Name:JOHN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9619
Mailing Address - Country:US
Mailing Address - Phone:262-206-2323
Mailing Address - Fax:
Practice Address - Street 1:7230 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1002
Practice Address - Country:US
Practice Address - Phone:262-242-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5811225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist