Provider Demographics
NPI:1558560474
Name:JANE K BRYANT
Entity Type:Organization
Organization Name:JANE K BRYANT
Other - Org Name:KIDS KABIN
Other - Org Type:Other Name
Authorized Official - Title/Position:OTR/SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:KITTRELL
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPY
Authorized Official - Phone:865-376-4620
Mailing Address - Street 1:187 GALLAHER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-4721
Mailing Address - Country:US
Mailing Address - Phone:865-376-4620
Mailing Address - Fax:865-376-1759
Practice Address - Street 1:187 GALLAHER RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4721
Practice Address - Country:US
Practice Address - Phone:865-376-4620
Practice Address - Fax:865-376-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN004074553OtherBCBS GROUP PROVIDER NUMBE