Provider Demographics
NPI:1578456240
Name:STARK, BRIA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:MARIE
Last Name:STARK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W BROOKLINE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7157
Mailing Address - Country:US
Mailing Address - Phone:262-902-5883
Mailing Address - Fax:
Practice Address - Street 1:1410 PLAZA DR STE 9
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1470
Practice Address - Country:US
Practice Address - Phone:262-902-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist