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NPI Code Detail

MEDICARE: KRYSTAL BRYSON OTR/L

MEDICARE:   KRYSTAL  BRYSON  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 TherapistOT010000840DC

General Provider Information

NPI Number : 1972942324
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL BRYSON OTR/L
Provider Business Mailing Address
First Line : 4305 DANLOU DR
Second Line :
City : BALTIMORE
State : MD
Zip : 21207-6407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10 G ST NE
Second Line : SUITE 710
City : WASHINGTON
State : DC
Zip : 20002-4213
Country : US
Telephone Number : 202-575-5404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2013
Last Update Date : 06/19/2013

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Directions to “ KRYSTAL BRYSON OTR/L” Practice Location

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