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Individual

BRIANNE KRISTIN SOUTHWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4411 N HABANA AVE, TAMPA, FL 33614-7211
(813) 872-2771
Mailing address
831 HOLLAHAN RD SE, PALM BAY, FL 32909-4942
(863) 812-2863

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OTA17712
FL
225X00000X
Occupational Therapist
Primary
OT24969
FL

Other

Enumeration date
04/08/2020
Last updated
02/19/2024
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