MEDICARE: DR. MYLES L COOLEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY2839	FL

General Provider Information

NPI Number	:	1326033473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYLES L COOLEY PH.D.

Provider Business Mailing Address
First Line	:	9121 N MILITARY TRL
Second Line	:	SUITE 218
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-5984
Country	:	US
Telephone Number	:	561-694-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	9121 N MILITARY TRL
Second Line	:	SUITE 218
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-5984
Country	:	US
Telephone Number	:	561-694-0001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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