=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346492071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY DENISE BRYANT OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2008
-----------------------------------------------------
Last Update Date | 04/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 TENDRILL CT
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-750-1991
-----------------------------------------------------
Fax | 855-686-3533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 HOPESTONE XING
-----------------------------------------------------
City | IRMO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29063-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-750-1991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2834
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------