Provider Demographics
NPI:1457628216
Name:BRYANT, ELIZABETH J (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2694
Mailing Address - Country:US
Mailing Address - Phone:678-316-4080
Mailing Address - Fax:
Practice Address - Street 1:4640 MARTIN RD STE 300
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5571
Practice Address - Country:US
Practice Address - Phone:678-679-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist