Provider Demographics
NPI:1346492071
Name:BRYANT, KIMBERLY DENISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:BRYANT
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:421 HOPESTONE XING
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7603
Mailing Address - Country:US
Mailing Address - Phone:803-750-1991
Mailing Address - Fax:
Practice Address - Street 1:305 TENDRILL CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3842
Practice Address - Country:US
Practice Address - Phone:803-750-1991
Practice Address - Fax:855-686-3533
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist