Provider Demographics
NPI:1184261810
Name:BRYD, KATHRYN FOY
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FOY
Last Name:BRYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:GRACE
Other - Last Name:FOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6225 LAPIS LN
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5424
Mailing Address - Country:US
Mailing Address - Phone:850-865-0754
Mailing Address - Fax:
Practice Address - Street 1:24 HOLLYWOOD BLVD SW STE 7
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4893
Practice Address - Country:US
Practice Address - Phone:850-226-7411
Practice Address - Fax:850-226-7496
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OT20469OtherOCCUPATIONAL THERAPY LICENSE