Provider Demographics
NPI:1366003071
Name:BRINKMEIER, CIARA (OTR/L)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:BRINKMEIER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CIARA
Other - Middle Name:
Other - Last Name:LIGHTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104
Mailing Address - Country:US
Mailing Address - Phone:815-440-3242
Mailing Address - Fax:
Practice Address - Street 1:209 9TH ST 302
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:815-748-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist