Healthcare Provider Details

I. General information

NPI: 1619491214
Provider Name (Legal Business Name): THERESE KATERI BYRNE L.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 PORTAGE RD STE 6
WOOSTER OH
44691-1900
US

IV. Provider business mailing address

2650 WINCHESTER WOODS APT I
WOOSTER OH
44691-5333
US

V. Phone/Fax

Practice location:
  • Phone: 330-234-1226
  • Fax:
Mailing address:
  • Phone: 614-935-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000332
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.022503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: