Basic Information
| Provider Information | |||||||||
| NPI: | 1639581457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | MS, OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | VANVOLKENBURG | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | CHRISTINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1908 ELSIE CIR NE | ||||||||
| Address2: | |||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284519216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148066003 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 235 N NC 41 HWY | ||||||||
| Address2: | |||||||||
| City: | BEULAVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285188633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102985877 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 9592 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.