Provider Demographics
NPI:1417338096
Name:BYLER, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:BYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10611 NW STATE ROAD 20
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3441
Mailing Address - Country:US
Mailing Address - Phone:850-591-4737
Mailing Address - Fax:
Practice Address - Street 1:10611 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3441
Practice Address - Country:US
Practice Address - Phone:850-591-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist