Provider Demographics
NPI:1366821753
Name:O'BRYAN, AMY P (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:P
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 GRIFFIN GATE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2739
Mailing Address - Country:US
Mailing Address - Phone:502-417-1092
Mailing Address - Fax:
Practice Address - Street 1:159 SAINT MATTHEWS AVE STE 10
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3137
Practice Address - Country:US
Practice Address - Phone:502-899-7105
Practice Address - Fax:502-899-1403
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist