Provider Demographics
NPI:1467603316
Name:BYRLEY, IBEITA (MED, BIA)
Entity Type:Individual
Prefix:
First Name:IBEITA
Middle Name:
Last Name:BYRLEY
Suffix:
Gender:F
Credentials:MED, BIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3699 ALEXANDRIA PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1789
Mailing Address - Country:US
Mailing Address - Phone:859-572-0430
Mailing Address - Fax:
Practice Address - Street 1:3699 ALEXANDRIA PIKE STE D
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-1789
Practice Address - Country:US
Practice Address - Phone:859-572-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200212649222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist