Bryn Elizabeth Wasserman, MA OTRL

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

102823 Issued in MN

Practice address

3001 Harbor Lane North
Suite 120
Plymouth, MN 55447

Phone

(651) 773-0354

Fax

(651) 773-0371

NPI assigned

Feb 15, 2007

Last updated

Oct 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1063555373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14401 IODINE ST NW",
            "address_2": "UNIT 21",
            "city": "RAMSEY",
            "state": "MN",
            "postal_code": "553034729",
            "telephone_number": "612-423-6075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 HARBOR LANE NORTH",
            "address_2": "SUITE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55447",
            "telephone_number": "651-773-0354",
            "fax_number": "651-773-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "BRYN",
        "middle_name": "ELIZABETH",
        "credential": "MA OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MN",
            "license": "102823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Occupational Therapist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Pediatric Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.