Healthcare Provider Details

I. General information

NPI: 1245559996
Provider Name (Legal Business Name): CYNTHIA ANN BYRD M.A.-O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N. 29TH ST.
MONROE LA
71201
US

IV. Provider business mailing address

810 N 29TH ST
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1223
  • Fax: 318-323-1224
Mailing address:
  • Phone: 318-323-1223
  • Fax: 318-323-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.Z12009
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTTZ12009
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: