Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 224Z00000X | Occupational Therapy Assistant | 411509 | OR |
NPI | 1013334192 |
---|---|
Provider Name | Angela Michelle Byers |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Eugene, OR 97401-6524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 03/01/2019 |