Provider Demographics
NPI:1255538567
Name:BYERLY, COLE ANDREW (BA)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:ANDREW
Last Name:BYERLY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 NW HIGHWAY 99
Mailing Address - Street 2:UNIT #24
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9002
Mailing Address - Country:US
Mailing Address - Phone:541-908-4499
Mailing Address - Fax:
Practice Address - Street 1:229 SOUTH EAST 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97231
Practice Address - Country:US
Practice Address - Phone:541-928-4084
Practice Address - Fax:541-928-9259
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator