Provider Demographics
NPI:1114467941
Name:BRYANT, CARRIE (OTR)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18596 LEE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-8004
Mailing Address - Country:US
Mailing Address - Phone:276-525-6043
Mailing Address - Fax:888-233-7885
Practice Address - Street 1:18596 LEE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-8004
Practice Address - Country:US
Practice Address - Phone:276-525-6043
Practice Address - Fax:888-233-7885
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004454225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist