Provider Demographics
NPI:1295062479
Name:BYL, BRENDA L (COTA)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:BYL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 WATER TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2135
Mailing Address - Country:US
Mailing Address - Phone:231-592-1061
Mailing Address - Fax:231-592-5139
Practice Address - Street 1:745 WATER TOWER RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2135
Practice Address - Country:US
Practice Address - Phone:231-592-1061
Practice Address - Fax:231-592-5139
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006875224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant