Provider Demographics
NPI:1114093234
Name:BRYSON, KELLY STEPHENS (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:STEPHENS
Last Name:BRYSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MARCELLE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1619 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-890-9119
Mailing Address - Fax:
Practice Address - Street 1:420 NORTH UNIVERSITY STREET
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-893-2602
Practice Address - Fax:615-890-1224
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist