Healthcare Provider Details

I. General information

NPI: 1841724259
Provider Name (Legal Business Name): BRYNNE COUPLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 SKYVIEW PL
CHULUOTA FL
32766-9539
US

IV. Provider business mailing address

344 SKYVIEW PL
CHULUOTA FL
32766-9539
US

V. Phone/Fax

Practice location:
  • Phone: 407-754-4398
  • Fax:
Mailing address:
  • Phone: 407-754-4398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 18296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: