Healthcare Provider Details

I. General information

NPI: 1184577934
Provider Name (Legal Business Name): MICHELE L MYERS OTA-050267
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 E ELEANA LN
GILBERT AZ
85298-8754
US

IV. Provider business mailing address

3109 E ELEANA LN
GILBERT AZ
85298-8754
US

V. Phone/Fax

Practice location:
  • Phone: 480-612-7100
  • Fax:
Mailing address:
  • Phone: 480-612-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTA-050267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: