Provider Demographics
NPI:1578301511
Name:BUMGARNER, BRIANNA NICOLE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:NICOLE
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-4249
Mailing Address - Country:US
Mailing Address - Phone:336-751-3535
Mailing Address - Fax:
Practice Address - Street 1:498 MADISON RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-4249
Practice Address - Country:US
Practice Address - Phone:336-751-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist