Provider Demographics
NPI:1154800258
Name:BYRON, KIMBERLY (COTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BYRON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 LAKE AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7386
Mailing Address - Country:US
Mailing Address - Phone:860-620-3499
Mailing Address - Fax:
Practice Address - Street 1:1 GLEN HILL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4921
Practice Address - Country:US
Practice Address - Phone:203-744-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1651224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant