Provider Demographics
NPI:1578139242
Name:HAMBLIN, BRYNN ALYSSA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:ALYSSA
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:ALYSSA
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:986 S 600 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5951
Mailing Address - Country:US
Mailing Address - Phone:480-369-6535
Mailing Address - Fax:
Practice Address - Street 1:24 W SERGEANT COURT DR STE 204
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5809
Practice Address - Country:US
Practice Address - Phone:801-987-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12118290-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant