Provider Demographics
NPI:1780750596
Name:BRYAN, GINA LYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LYNN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LYNN
Other - Last Name:FILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:14507 BOURBON ST SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5810
Mailing Address - Country:US
Mailing Address - Phone:304-813-0202
Mailing Address - Fax:
Practice Address - Street 1:309 WILLOWBROOK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2500
Practice Address - Country:US
Practice Address - Phone:301-777-2170
Practice Address - Fax:301-777-2173
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist