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General NPI Number Information
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NPI Number | 1083231567
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Entity Type | Individual
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Provider Name | JESSIE-LYNN KELLEY MYERS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 1488 OLD OCILLA RD
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City | TIFTON
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State | GA
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Zip | 31794-4152
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Country | US
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Telephone | 229-386-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1298 ED LINDSEY RD
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City | LENOX
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State | GA
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Zip | 31637-4928
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Country | US
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Telephone | 386-590-6194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT007776
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License Number State | GA
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