Provider Demographics
NPI:1093443806
Name:BRYDON, KIRSTEN SARYSSA (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KIRSTEN
Middle Name:SARYSSA
Last Name:BRYDON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 JOANN CT
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2088
Mailing Address - Country:US
Mailing Address - Phone:810-299-1742
Mailing Address - Fax:
Practice Address - Street 1:465 N HOOPER ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1406
Practice Address - Country:US
Practice Address - Phone:989-672-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist