Provider Demographics
NPI:1154708311
Name:HASSA, BRIELLE NICOLE (MS OTR/L)
Entity type:Individual
Prefix:MISS
First Name:BRIELLE
Middle Name:NICOLE
Last Name:HASSA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 WILLIAM BLISS DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1462
Mailing Address - Country:US
Mailing Address - Phone:201-638-6596
Mailing Address - Fax:
Practice Address - Street 1:679 WILLIAM BLISS DR
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1462
Practice Address - Country:US
Practice Address - Phone:201-638-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00696200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist