Provider Demographics
NPI:1386228641
Name:PUTNAM-BRYANT, DELORA V (ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:DELORA
Middle Name:V
Last Name:PUTNAM-BRYANT
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6922
Mailing Address - Country:US
Mailing Address - Phone:414-262-6969
Mailing Address - Fax:
Practice Address - Street 1:7646 N TEUTONIA AVE
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1736
Practice Address - Country:US
Practice Address - Phone:414-797-2155
Practice Address - Fax:414-797-2156
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14-304221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14-3062691OtherART THERAPY HOUSE, INC