=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437915030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYN STRONG OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2024
-----------------------------------------------------
Last Update Date | 02/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6955 FOOTHILL BLVD # 188
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94605-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-362-2179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 KELLIE ANN CT
-----------------------------------------------------
City | ORINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94563-3206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-710-3187
-----------------------------------------------------
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 | 17876
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------