Provider Demographics
NPI:1154722056
Name:BRYANT, KRISTIN (OTR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BRYANT
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 1:197 SPRING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3643
Mailing Address - Country:US
Mailing Address - Phone:434-953-1477
Mailing Address - Fax:
Practice Address - Street 1:197 SPRING OAKS LN
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3643
Practice Address - Country:US
Practice Address - Phone:434-953-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
0119006438225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist