Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2311 | OK |
NPI | 1003495847 |
---|---|
Provider Name | Marc Byles |
First Address | Oklahoma City, OK 73112-2916 |
Second Address | Oklahoma City, OK 73112-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2021 |
Last Update Date | 07/04/2021 |