Provider Demographics
NPI:1972334472
Name:CORREIA, BRIANNA (OTD, OTR)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:CORREIA
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BASTROP HWY S APT 723
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-4329
Mailing Address - Country:US
Mailing Address - Phone:503-807-2966
Mailing Address - Fax:
Practice Address - Street 1:10127 MOROCCO ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3938
Practice Address - Country:US
Practice Address - Phone:210-838-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124787225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist