Provider Demographics
NPI:1669857967
Name:DYESS, TARYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:DYESS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TRYSTAN DR
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2839
Mailing Address - Country:US
Mailing Address - Phone:601-408-1150
Mailing Address - Fax:
Practice Address - Street 1:24 TRYSTAN DR
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2839
Practice Address - Country:US
Practice Address - Phone:601-408-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA2646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist