Provider Demographics
NPI:1205579265
Name:BRYANT, JEANINE ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:ANN
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 1:5650 VILLAS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2453
Mailing Address - Country:US
Mailing Address - Phone:513-675-2914
Mailing Address - Fax:
Practice Address - Street 1:5650 VILLAS CREEK DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2453
Practice Address - Country:US
Practice Address - Phone:513-675-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT002632225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist