Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT17576 | FL |
NPI | 1003370610 |
---|---|
Provider Name | Mrs. Michele Constance Bryant |
First Address | Troy, MI 48084-1265 |
Second Address | South Pasadena, FL 33707-4601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2019 |
Last Update Date | 28/01/2019 |