Healthcare Provider Details

I. General information

NPI: 1184891004
Provider Name (Legal Business Name): CHRISTOPHER EVERETTE BYRD OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 ERIN WAY
BOWLING GREEN KY
42104
US

IV. Provider business mailing address

1722 ERIN WAY
BOWLING GREEN KY
42104-4518
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-5967
  • Fax:
Mailing address:
  • Phone: 270-782-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR1821
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: