Basic Information
Provider Information
NPI: 1538409735
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROUNSVILLE
FirstName: BRITTANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 SHAWNEE ROAD
Address2:  
City: LIMA
State: OH
PostalCode: 45805
CountryCode: US
TelephoneNumber: 4199992030
FaxNumber: 4199910909
Practice Location
Address1: 1028 E. SECOND STREET
Address2:  
City: COUDERSPORT
State: PA
PostalCode: 169158306
CountryCode: US
TelephoneNumber: 8142747610
FaxNumber: 8142748010
Other Information
ProviderEnumerationDate: 02/25/2013
LastUpdateDate: 12/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOC012322PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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