Healthcare Provider Details

I. General information

NPI: 1427242593
Provider Name (Legal Business Name): KIMBERLY ROXANN BRYANT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ROXANN MEEKS

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 GUNBARREL RD SUITE 201
CHATTANOOGA TN
37421-7197
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-892-8070
  • Fax: 423-858-0323
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3619
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: