Individual
JENNIFER LEE BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTL
Contact information
Practice address
222 W PINE ST, LODI, CA 95240-2020
(209) 368-1009
(209) 368-1024
Mailing address
222 W PINE ST, LODI, CA 95240-2020
(209) 368-1009
(209) 368-1024
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00945625
RAILROAD MEDICARE PTAN
CA
Enumeration date
01/09/2007
Last updated
08/23/2011
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