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NPI Code Detail

MEDICARE: MISS KRISTIN KELLY MYERS OTA

MEDICARE: MISS KRISTIN KELLY MYERS OTA
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
1224Z00000XOccupational Therapy Assistant00692IA

General Provider Information

NPI Number : 1497950562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KRISTIN KELLY MYERS OTA
Provider Business Mailing Address
First Line : 1056 CRESS PKWY
Second Line :
City : HIAWATHA
State : IA
Zip : 52233-1838
Country : US
Telephone Number : 319-981-4038
Fax Number :
Provider Business Practice Location Address
First Line : 3661 ROCHESTER AVE
Second Line :
City : IOWA CITY
State : IA
Zip : 52245-9271
Country : US
Telephone Number : 319-351-7460
Fax Number : 319-341-6229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2007
Last Update Date : 07/08/2007

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