MEDICARE: ANGELA MYERS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1447740568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MYERS

Provider Business Mailing Address
First Line	:	4101 LAKE GEORGE RD
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9635
Country	:	US
Telephone Number	:	254-319-6042
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 LAKE GEORGE RD
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9635
Country	:	US
Telephone Number	:	254-319-6042
Fax Number	:

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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