Provider Demographics
NPI:1568825453
Name:BYARS, PAMELA MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:BYARS
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 1:14877 LEHMAN RD
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:MO
Mailing Address - Zip Code:65034-2228
Mailing Address - Country:US
Mailing Address - Phone:660-337-6367
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-302-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant