Provider Demographics
NPI:1013489301
Name:BYERLY, BRIANNE CONNIE
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:CONNIE
Last Name:BYERLY
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 1:7586 L AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:IA
Mailing Address - Zip Code:52142-9247
Mailing Address - Country:US
Mailing Address - Phone:563-920-4132
Mailing Address - Fax:
Practice Address - Street 1:204 E CHARLES ST
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1940
Practice Address - Country:US
Practice Address - Phone:319-283-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094753225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist