Provider Demographics
NPI:1639302722
Name:MOTYCKA, BRYAN CLAUDE (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CLAUDE
Last Name:MOTYCKA
Suffix:
Gender:M
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 12TH AVE S APT 1705
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6634
Mailing Address - Country:US
Mailing Address - Phone:615-477-5179
Mailing Address - Fax:
Practice Address - Street 1:103 ARCARO PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5061
Practice Address - Country:US
Practice Address - Phone:615-376-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist