Magan Renee Brissel, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

1573 Issued in TN

Practice address

1842 Wilma Rudoph Blvd
Clarksville, TN 37040

Phone

(931) 906-0440

Fax

(931) 920-5070

NPI assigned

Dec 5, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Full Spectrum Pediatric Therapy, Inc.

  • Physical Therapist
  • Clarksville, TN
  • NPI 1255472403
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1710169347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1842 WILMA RUDOPH BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37040",
            "telephone_number": "931-906-0440",
            "fax_number": "931-920-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1842 WILMA RUDOPH BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37040",
            "telephone_number": "931-906-0440",
            "fax_number": "931-920-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISSEL",
        "first_name": "MAGAN",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TN",
            "license": "1573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE TN",
            "identifier": "1573",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie Danielle Brietenmoser
• Brighter Day Health LLC
• Ashly Renee Brimeyer, LMT
• Erin Whitney Brinks, LMSW
• Lakesha Nicole Brisbane
• Laura Brittian, MSW
• Joseph A Britton, D.D.S.
• April M Brobston, LPC
• Ashley Elizabeth Brock
• Liana Brock

• Occupational Therapy Assistant in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Occupational Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.