Individual
MISS BREANNA MARIE KALANISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1543 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 363-2273
Mailing address
20909 PLEASANT VIEW LN SW, RAWLINGS, MD 21557-2508
(301) 357-0376
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C2264
WV
Other
Enumeration date
04/14/2019
Last updated
04/14/2019
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