Provider Demographics
NPI:1013544022
Name:SMITH, BRYCE CARSONE (OTD)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:CARSONE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 SHERYL DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4512
Mailing Address - Country:US
Mailing Address - Phone:330-565-8636
Mailing Address - Fax:
Practice Address - Street 1:3035 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4144
Practice Address - Country:US
Practice Address - Phone:440-356-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010148208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation