Provider Demographics
NPI:1144092768
Name:SWANSON, BRIONNA MAY (COTA/L)
Entity type:Individual
Prefix:
First Name:BRIONNA
Middle Name:MAY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 ASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9728
Mailing Address - Country:US
Mailing Address - Phone:910-964-4066
Mailing Address - Fax:
Practice Address - Street 1:4706 ASHVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14710-9728
Practice Address - Country:US
Practice Address - Phone:910-964-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19812225700000X
NC15201224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist