Provider Demographics
NPI:1952351595
Name:BYRNE, TODD OTTO (OTR, CHT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:OTTO
Last Name:BYRNE
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7161
Mailing Address - Country:US
Mailing Address - Phone:903-780-8957
Mailing Address - Fax:903-787-7796
Practice Address - Street 1:6013 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4410
Practice Address - Country:US
Practice Address - Phone:903-363-9932
Practice Address - Fax:800-503-4607
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108108225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist