Provider Demographics
NPI:1942843958
Name:BUTZMAN, BRYNN NIKELEN (OTD, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:BRYNN
Middle Name:NIKELEN
Last Name:BUTZMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 ANTHEM VILLAGE DR STE E380
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-867-4266
Mailing Address - Fax:702-867-4261
Practice Address - Street 1:10907 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5863
Practice Address - Country:US
Practice Address - Phone:702-867-4266
Practice Address - Fax:702-867-4261
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2389225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics