Healthcare Provider Details

I. General information

NPI: 1811698202
Provider Name (Legal Business Name): BRYLIE BRYANT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRYLIE WINGLER OTR/L

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10006 N DALE MABRY HWY STE 202
TAMPA FL
33618-4422
US

IV. Provider business mailing address

375 54TH AVE N UNIT 2208
ST PETERSBURG FL
33703-2240
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-0442
  • Fax:
Mailing address:
  • Phone: 757-472-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number24005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: