Provider Demographics
NPI:1427242593
Name:BRYANT, KIMBERLY ROXANN (OT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROXANN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ROXANN
Other - Last Name:MEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1608 GUNBARREL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7197
Practice Address - Country:US
Practice Address - Phone:423-892-8070
Practice Address - Fax:423-858-0323
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT3619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN5441975Medicaid
TN3156797OtherBCBST
TN0446652Medicaid