Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 118345 | TX |
Y | 225XM0800X | Mental Health | 19847 | CA |
NPI | 1548797400 |
---|---|
Provider Name | Ericka L Bryant |
First Address | Fort Worth, TX 76112-6849 |
Second Address | Fort Worth, TX 76112-6849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 25/02/2020 |