Provider Demographics
NPI:1528261070
Name:BRYSON, MOLLY JO (OTR)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JO
Last Name:BRYSON
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 1:303 HILLDALE AVE
Mailing Address - Street 2:PO BOX 711
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-3517
Mailing Address - Country:US
Mailing Address - Phone:864-981-4825
Mailing Address - Fax:864-938-9240
Practice Address - Street 1:304 JACOBS HWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7279
Practice Address - Country:US
Practice Address - Phone:864-833-2550
Practice Address - Fax:864-938-9240
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist