MEDICARE: LAURA BRYANT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver	OH
2	347C00000X	Private Vehicle	OH
3	3747P1801X	Personal Care Attendant	OH

General Provider Information

NPI Number	:	1568203594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BRYANT

Provider Business Mailing Address
First Line	:	161 E CENTRAL AVE
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-2201
Country	:	US
Telephone Number	:	234-703-6968
Fax Number	:

Provider Business Practice Location Address
First Line	:	4779 VALLEY HILLS DR
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-9328
Country	:	US
Telephone Number	:	234-703-6968
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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Directions to “ LAURA BRYANT ” Practice Location

Language	Start Address	Practice Location

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