1649886532 NPI number — BRIANNE MARIE GAINES OTD, OTR/L

Table of content: BRIANNE MARIE GAINES OTD, OTR/L (NPI 1649886532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649886532 NPI number — BRIANNE MARIE GAINES OTD, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINES
Provider First Name:
BRIANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTD, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BULLEIGH
Provider Other First Name:
BRIANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTD, OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649886532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17055 FRANCES ST STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68130-4655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-280-2200
Provider Business Mailing Address Fax Number:
402-280-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CREIGHTON PEDIATRIC THERAPY
Provider Second Line Business Practice Location Address:
17055 FRANCES ST STE 103
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68130-4655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-780-2200
Provider Business Practice Location Address Fax Number:
402-280-2210
Provider Enumeration Date:
09/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2466 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com