Provider Demographics
NPI:1811482417
Name:DYKSTRA, BRIANA LYNN (OTR)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:LYNN
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:LYNN
Other - Last Name:SEAKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4870 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4432
Mailing Address - Country:US
Mailing Address - Phone:765-254-9717
Mailing Address - Fax:765-254-9739
Practice Address - Street 1:4870 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4432
Practice Address - Country:US
Practice Address - Phone:765-254-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99086492A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist