Provider Demographics
NPI:1114503927
Name:BYRNE, JENNIFER LEE MERIAN (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE MERIAN
Last Name:BYRNE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 DEGREGOIRE PARK
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-7554
Mailing Address - Country:US
Mailing Address - Phone:540-632-8909
Mailing Address - Fax:
Practice Address - Street 1:4415 COLUMBINE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8039
Practice Address - Country:US
Practice Address - Phone:540-632-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61148977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist