Basic Information
| Provider Information | |||||||||
| NPI: | 1922248228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVALOS | ||||||||
| FirstName: | BRIYITH | ||||||||
| MiddleName: | KATERINE | ||||||||
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| Credential: | M.S. OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 673 MDG | ||||||||
| Address2: | 5955 ZEAMER AVENUE | ||||||||
| City: | JBER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075801530 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 673 MDG | ||||||||
| Address2: | 5955 ZEAMER AVENUE | ||||||||
| City: | JBER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075801530 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.