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NPI Code Detail

MEDICARE: LEANNE NICOLE BRYAN MOT, OTR/L

MEDICARE:   LEANNE NICOLE BRYAN  MOT, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist0119003924VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235152661
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANNE NICOLE BRYAN MOT, OTR/L
Provider Business Mailing Address
First Line : 8270 WILLOW OAKS CORPORATE DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8270 WILLOW OAKS CORPORATE DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4511
Country : US
Telephone Number : 571-423-4864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 03/17/2018

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Directions to “ LEANNE NICOLE BRYAN MOT, OTR/L” Practice Location

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