Provider Demographics
NPI:1396185559
Name:SPALDING, BRYANT (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:SPALDING
Suffix:
Gender:M
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 1:126 N PETERSON AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2337
Mailing Address - Country:US
Mailing Address - Phone:502-614-9362
Mailing Address - Fax:
Practice Address - Street 1:126 N PETERSON AVE
Practice Address - Street 2:APT. 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2337
Practice Address - Country:US
Practice Address - Phone:502-614-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY122995225X00000X
KYR4377225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist