Provider Demographics
NPI:1194942169
Name:BRYK, TARA (OT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BRYK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LUZERNE AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1600
Mailing Address - Country:US
Mailing Address - Phone:570-262-5229
Mailing Address - Fax:
Practice Address - Street 1:200 S MEADE ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6221
Practice Address - Country:US
Practice Address - Phone:570-262-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist