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General NPI Number Information
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NPI Number | 1619491214
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Entity Type | Individual
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Provider Name | THERESE KATERI BYRNE L.AC., LMT
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 2056 PORTAGE RD STE 6
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City | WOOSTER
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State | OH
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Zip | 44691-1900
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Country | US
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Telephone | 330-234-1226
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 WINCHESTER WOODS APT I
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City | WOOSTER
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State | OH
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Zip | 44691-5333
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Country | US
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Telephone | 614-935-8041
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 65.000332
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.022503
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License Number State | OH
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