Provider Demographics
NPI:1336761139
Name:BYERLY, JENELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:BYERLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BAMBI TRL
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2963
Mailing Address - Country:US
Mailing Address - Phone:603-494-3913
Mailing Address - Fax:
Practice Address - Street 1:6A KITTY HAWK LNDG
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-2048
Practice Address - Country:US
Practice Address - Phone:603-432-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NH2946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2946OtherNH BOARD OF ALLIED HEALTH