Basic Information
Provider Information
NPI: 1003000787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HYDE
FirstName: CYNDI
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: COTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2246 WATERFORD ST SE
Address2:  
City: ALBANY
State: OR
PostalCode: 973228877
CountryCode: US
TelephoneNumber: 5419053250
FaxNumber:  
Practice Location
Address1: 1485 INTERNATIONAL PKWY STE 2051
Address2:  
City: HEATHROW
State: FL
PostalCode: 327465352
CountryCode: US
TelephoneNumber: 8007986035
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/05/2007
LastUpdateDate: 09/05/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000X4566WIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


Home