MEDICARE: MS. JULIE ALEXANDRE BRYAN MS, 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
1	171W00000X	Contractor	9640	MA

General Provider Information

NPI Number	:	1467604322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE ALEXANDRE BRYAN MS, OTR/L

Provider Business Mailing Address
First Line	:	1 WASHINGTON ST
Second Line	:
City	:	TYNGSBORO
State	:	MA
Zip	:	01879-1258
Country	:	US
Telephone Number	:	978-761-7156
Fax Number	:

Provider Business Practice Location Address
First Line	:	13609 CALIFORNIA ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-5260
Country	:	US
Telephone Number	:	800-456-5857
Fax Number	:

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

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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