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General NPI Number Information
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NPI Number | 1891343398
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Entity Type | Individual
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Provider Name | BRYCEN NICOLE RAYBON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 164 W 79TH ST APT 1C
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City | NEW YORK
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State | NY
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Zip | 10024-6440
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Country | US
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Telephone | 212-712-2014
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 2ND AVE APT 3F
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City | NEW YORK
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State | NY
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Zip | 10128-3520
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Country | US
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Telephone | 972-249-7503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 120093
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 023718
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License Number State | NY
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