Provider Demographics
NPI:1235462383
Name:BRYZE, KIMBERLY ALLISON (PHD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALLISON
Last Name:BRYZE
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 31ST ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1235
Mailing Address - Country:US
Mailing Address - Phone:630-515-7226
Mailing Address - Fax:
Practice Address - Street 1:555 31ST ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1235
Practice Address - Country:US
Practice Address - Phone:630-515-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-000679225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics