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NPI Code Detail

MEDICARE: WANDA BRYANT DT

MEDICARE: WANDA BRYANT DT
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1932378718
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANDA BRYANT DT
Provider Business Mailing Address
First Line : 5820 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2616
Country : US
Telephone Number : 773-685-8482
Fax Number :
Provider Business Practice Location Address
First Line : 5820 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2616
Country : US
Telephone Number : 773-685-8482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2008
Last Update Date : 02/26/2008

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Directions to “ WANDA BRYANT DT” Practice Location

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