Provider Demographics
NPI:1265678304
Name:WILKINSON, BRYANT DAVID (OT)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:DAVID
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 W 3RD ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3836
Mailing Address - Country:US
Mailing Address - Phone:315-264-4151
Mailing Address - Fax:
Practice Address - Street 1:299 E RIVER RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6400
Practice Address - Country:US
Practice Address - Phone:315-342-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP66327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist