Provider Demographics
NPI:1861644882
Name:BRYANT, LEIGH MICHELLE (OT/R)
Entity Type:Individual
Prefix:MS
First Name:LEIGH
Middle Name:MICHELLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:OT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2950
Mailing Address - Country:US
Mailing Address - Phone:336-972-4967
Mailing Address - Fax:
Practice Address - Street 1:120 HEATHER CT
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2950
Practice Address - Country:US
Practice Address - Phone:336-972-4967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist