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General NPI Number Information
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NPI Number | 1073111654
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Entity Type | Individual
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Provider Name | MARY V BYRD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 37 STERLING RD
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City | MARIETTA
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State | OH
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Zip | 45750
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Country | US
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Telephone | 740-516-4496
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 283
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City | RENO
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State | OH
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Zip | 45773-0283
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 8401723
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License Number State | OH
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