Individual
STACEY BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
530 OAK HILL DR, EDWARDSVILLE, IL 62025-2024
(618) 670-3552
Mailing address
530 OAK HILL DR, EDWARDSVILLE, IL 62025-2024
(618) 670-3552
Taxonomy
Speciality
Code
Description
License number
State
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
Primary
057-002567
IL
Other
Enumeration date
05/07/2021
Last updated
05/07/2021
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