Michelle Lynn Bryan, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

31002229A Issued in IN

Practice address

1101 Michigan Ave
Logansport, IN 46947-1528

Phone

(574) 753-1380

Fax

(574) 753-1589

NPI assigned

Jun 23, 2005

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

Other identifiers 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northcentral in Sports Medicine

  • Physical Therapy Assistant
  • Logansport, IN
  • NPI 1619191210
  NPD (past)
• Northcentral Indiana Sports Medicine Center

  • Physical Therapy Clinic/Center
  • Logansport, IN
  • NPI 1427267715
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1346246451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 GREENLAWN DR",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471316",
            "telephone_number": "574-753-1380",
            "fax_number": "574-753-1589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471528",
            "telephone_number": "574-753-1380",
            "fax_number": "574-753-1589"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 W 2nd St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Peru",
            "state": "IN",
            "postal_code": "469701385",
            "country_code": "US",
            "telephone_number": "765-919-4444",
            "fax_number": "574-753-1589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31002229A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000179073",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER INSURANCES",
            "identifier": "351780783",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAGAMORE",
            "identifier": "351780783",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Brown
• Dianne J Brown, O.D.
• Jerri Lynn Brown
• Rachel Marie Brown, RN
• Ronald C. Brown, D.C.
• Gaylynn Fay Burke, RN
• Peter B. Burns, M.D.
• Courtney Allison Burton
• Joellen Burton, RN
• Kylie Noel Burton

• All providers in Logansport, IN
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; 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.