Provider Demographics
NPI:1053970384
Name:BRITTAIN, JOANNA DEE (COTA/L)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:DEE
Last Name:BRITTAIN
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 1:319 SW BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-1266
Mailing Address - Country:US
Mailing Address - Phone:859-878-0246
Mailing Address - Fax:
Practice Address - Street 1:319 SW BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-1266
Practice Address - Country:US
Practice Address - Phone:859-878-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16903224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant