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NPI Code Detail

MEDICARE: BRYNLEE GRACE DUTY OTR/L

MEDICARE: BRYNLEE GRACE DUTY 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 Therapist2025044964MO

General Provider Information

NPI Number : 1376494971
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYNLEE GRACE DUTY OTR/L
Provider Business Mailing Address
First Line : 1804 SW E ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72712-7864
Country : US
Telephone Number : 479-270-8831
Fax Number :
Provider Business Practice Location Address
First Line : 12634 OLIVE BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-6337
Country : US
Telephone Number : 314-996-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

Similar Medicare Providers

1326041997 — DR. PAUL SHERMAN LUX MD
Practice Location Address:
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Directions to “ BRYNLEE GRACE DUTY OTR/L” Practice Location

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