Individual
MRS. MICHELLE LYNN BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1101 MICHIGAN AVE, LOGANSPORT, IN 46947-1528
(574) 753-1380
(574) 753-1589
Mailing address
516 GREENLAWN DR, LOGANSPORT, IN 46947-1316
(574) 753-1380
(574) 753-1589
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31002229A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000179073
ANTHEM BLUE CROSS
IN
01
—
351780783
ALL OTHER INSURANCES
IN
Enumeration date
06/23/2005
Last updated
08/18/2022
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