Provider Demographics
NPI:1780786210
Name:BYERS, KENNETH (MS, OTR/L, CDRS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BYERS
Suffix:
Gender:M
Credentials:MS, OTR/L, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10694 ROUTE 116
Mailing Address - Street 2:APARTMENT #4
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-8501
Mailing Address - Country:US
Mailing Address - Phone:802-660-3951
Mailing Address - Fax:
Practice Address - Street 1:790 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3007
Practice Address - Country:US
Practice Address - Phone:802-847-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist