Provider Demographics
NPI:1730966201
Name:GARCIA, BRIANNA LISETTE (COTA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LISETTE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7537 N ETHAN ALLAN PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2125
Mailing Address - Country:US
Mailing Address - Phone:520-261-2208
Mailing Address - Fax:
Practice Address - Street 1:7537 N ETHAN ALLAN PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2125
Practice Address - Country:US
Practice Address - Phone:520-261-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant