Healthcare Provider Details

I. General information

NPI: 1962051243
Provider Name (Legal Business Name): COLLEEN MARY BYE OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 W RUSSELL RD STE 115
LAS VEGAS NV
89148-1238
US

IV. Provider business mailing address

9121 W RUSSELL RD STE 115
LAS VEGAS NV
89148-1238
US

V. Phone/Fax

Practice location:
  • Phone: 702-499-6638
  • Fax: 702-442-8929
Mailing address:
  • Phone: 702-499-6638
  • Fax: 702-442-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2349
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2349
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: