MEDICARE: MS. DEBBIE S BRYAN OT

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
1	174400000X	Specialist	807	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1336165240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBBIE S BRYAN OT

Provider Business Mailing Address
First Line	:	2305 CALLE DE REAL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3075
Country	:	US
Telephone Number	:	505-243-0777
Fax Number	:	505-243-0777

Provider Business Practice Location Address
First Line	:	2305 CALLE DE REAL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3075
Country	:	US
Telephone Number	:	505-243-0777
Fax Number	:	505-243-0777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/09/2007

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