Healthcare Provider Details

I. General information

NPI: 1366371148
Provider Name (Legal Business Name): BRYTON GRIFFITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N GROVE ST
MERRITT ISLAND FL
32953-3444
US

IV. Provider business mailing address

116 BOSKIND RD
INDIALANTIC FL
32903-2829
US

V. Phone/Fax

Practice location:
  • Phone: 321-449-8880
  • Fax:
Mailing address:
  • Phone: 321-507-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA19481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: