Healthcare Provider Details

I. General information

NPI: 1790602977
Provider Name (Legal Business Name): LONNIE NICOLE MYERS OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W OMAHA ST # 3
RAPID CITY SD
57701-8097
US

IV. Provider business mailing address

814 BAR FIVE RANCH RD
RAPID CITY SD
57703-4821
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-5950
  • Fax:
Mailing address:
  • Phone: 701-570-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: