Healthcare Provider Details

I. General information

NPI: 1821527235
Provider Name (Legal Business Name): MORGAN LEIGH MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 N 2100 ST
BEECHER CITY IL
62414
US

IV. Provider business mailing address

2536 N 2100 ST
BEECHER CITY IL
62414-2011
US

V. Phone/Fax

Practice location:
  • Phone: 618-554-2552
  • Fax:
Mailing address:
  • Phone: 618-554-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: