Provider Demographics
NPI:1588788467
Name:BRYTE, KATHY ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:BRYTE
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:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-0387
Mailing Address - Country:US
Mailing Address - Phone:520-906-2900
Mailing Address - Fax:
Practice Address - Street 1:16503 S THREE WELLS CT
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8920
Practice Address - Country:US
Practice Address - Phone:520-906-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0002171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ054594Medicaid