Provider Demographics
NPI:1558096966
Name:BRYAN, KASEY MICHELLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:MICHELLE
Last Name:BRYAN
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 1:1320 HIGHWAY 133 N
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-4857
Mailing Address - Country:US
Mailing Address - Phone:870-415-9137
Mailing Address - Fax:
Practice Address - Street 1:1036 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-8980
Practice Address - Country:US
Practice Address - Phone:870-853-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1707224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant