Healthcare Provider Details

I. General information

NPI: 1912136631
Provider Name (Legal Business Name): CASEE LEIGH BYRNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASEE LEIGH BYRNES MSOTR/L

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COOPER ST HERITAGE HALL SOUTH
AGAWAM MA
01001-2149
US

IV. Provider business mailing address

65 COOPER ST HERITAGE HALL SOUTH
AGAWAM MA
01001-2149
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax:
Mailing address:
  • Phone: 413-786-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9695
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: