Provider Demographics
NPI:1063555373
Name:WASSERMAN, BRYN ELIZABETH (MA OTRL)
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:ELIZABETH
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:
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Mailing Address - Street 1:14401 IODINE ST NW
Mailing Address - Street 2:UNIT 21
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4729
Mailing Address - Country:US
Mailing Address - Phone:612-423-6075
Mailing Address - Fax:
Practice Address - Street 1:3001 HARBOR LANE NORTH
Practice Address - Street 2:SUITE 120
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:651-773-0354
Practice Address - Fax:651-773-0371
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN102823225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics