MEDICARE: MR. TODD OTTO BYRNE OTR, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	108108	TX
2	225XH1200X	Hand Occupational Therapist	108108	TX

General Provider Information

NPI Number	:	1952351595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD OTTO BYRNE OTR, CHT

Provider Business Mailing Address
First Line	:	2900 S CAMERON AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-7161
Country	:	US
Telephone Number	:	903-780-8957
Fax Number	:	903-787-7796

Provider Business Practice Location Address
First Line	:	6013 S BROADWAY AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-4410
Country	:	US
Telephone Number	:	903-363-9932
Fax Number	:	800-503-4607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/06/2013

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