Provider Demographics
NPI:1629386560
Name:MILANI, BREEANA ELISE (OT)
Entity type:Individual
Prefix:
First Name:BREEANA
Middle Name:ELISE
Last Name:MILANI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BREENA
Other - Middle Name:ELISE
Other - Last Name:LAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1805
Mailing Address - Country:US
Mailing Address - Phone:231-737-4374
Mailing Address - Fax:231-830-9196
Practice Address - Street 1:23222 E ECHO LAKE RD
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-6813
Practice Address - Country:US
Practice Address - Phone:206-730-3236
Practice Address - Fax:206-735-3778
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007801225X00000X
WAOT60178233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist