Individual
KEITH BRISLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
109 TERRACE DR, OLYPHANT, PA 18447-2502
(570) 483-4603
(570) 319-1250
Mailing address
109 TERRACE DR, OLYPHANT, PA 18447-2502
(570) 483-4603
(570) 319-1250
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP002876L
PA
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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