Provider Demographics
NPI:1407333743
Name:PRYOR, DEVAN COSSU-EDWARDS (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:COSSU-EDWARDS
Last Name:PRYOR
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 1:5377 NIGHT STAR TRL
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4420
Mailing Address - Country:US
Mailing Address - Phone:561-706-6603
Mailing Address - Fax:
Practice Address - Street 1:7010 15TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5738
Practice Address - Country:US
Practice Address - Phone:727-200-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT19059OtherFLORIDA HEALTH LICENSE