Provider Demographics
NPI:1326027996
Name:BYRON, DENVER LEE (OTR CHT)
Entity Type:Individual
Prefix:MR
First Name:DENVER
Middle Name:LEE
Last Name:BYRON
Suffix:
Gender:M
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8419
Mailing Address - Country:US
Mailing Address - Phone:724-434-2720
Mailing Address - Fax:724-434-2710
Practice Address - Street 1:100 STOOPS DRIVE
Practice Address - Street 2:SUITE 280
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063
Practice Address - Country:US
Practice Address - Phone:724-483-4263
Practice Address - Fax:724-483-3154
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC 00438 OL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033189P3DMedicaid
PA977922OtherHIGHMARK BLUE SHIELD
P000153673OtherRAILROAD MEDICARE