Provider Demographics
NPI:1467230342
Name:BRYANT, RACHEL LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 ACAPULCO CIR
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5370
Mailing Address - Country:US
Mailing Address - Phone:256-458-8000
Mailing Address - Fax:
Practice Address - Street 1:22900 LYDEN DR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-7044
Practice Address - Country:US
Practice Address - Phone:239-221-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19638224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant