Provider Demographics
NPI:1962461921
Name:LANE, BRYONY MICHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRYONY
Middle Name:MICHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE S
Mailing Address - Street 2:PT/OT PARK PLACE, 3RD FLOOR
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-939-6289
Mailing Address - Fax:205-558-2077
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:PT/OT PARK PLACE, 3RD FLOOR
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-6289
Practice Address - Fax:205-558-2077
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2443225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890012130Medicaid