Provider Demographics
NPI:1003370610
Name:BRYANT, MICHELE CONSTANCE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:CONSTANCE
Last Name:BRYANT
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 1:3145 OAKHILL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1265
Mailing Address - Country:US
Mailing Address - Phone:248-515-2248
Mailing Address - Fax:
Practice Address - Street 1:1820 SHORE DR S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4601
Practice Address - Country:US
Practice Address - Phone:727-851-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17576225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist