Provider Demographics
NPI:1073873170
Name:BYARS, WILLIAM RANDAL (COTA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RANDAL
Last Name:BYARS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1512 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6023
Mailing Address - Country:US
Mailing Address - Phone:405-650-9029
Mailing Address - Fax:405-360-2527
Practice Address - Street 1:1512 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6023
Practice Address - Country:US
Practice Address - Phone:405-650-9029
Practice Address - Fax:405-360-2527
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK476224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant