Provider Demographics
NPI:1679135495
Name:WOLFGANG, BRITTANY NICHOLE (MASTERS)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICHOLE
Last Name:WOLFGANG
Suffix:
Gender:
Credentials:MASTERS
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:NICHOLE
Other - Last Name:ZEHNDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:184 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1255
Mailing Address - Country:US
Mailing Address - Phone:989-262-8500
Mailing Address - Fax:
Practice Address - Street 1:400 ROUNDS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1724
Practice Address - Country:US
Practice Address - Phone:810-629-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
MN5201013261225X00000X
MI5201013261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician