MEDICARE: OLIVIA MYERS OTRL

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	225X00000X	Occupational Therapist	5201011194	MI

General Provider Information

NPI Number	:	1407397482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MYERS OTRL

Provider Business Mailing Address
First Line	:	701 E GROVE ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-5270
Country	:	US
Telephone Number	:	586-623-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	16260 PARK LAKE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-9480
Country	:	US
Telephone Number	:	517-339-2322
Fax Number	:

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

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/22/2021

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Directions to “ OLIVIA MYERS OTRL” Practice Location

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