MEDICARE: JUDY ANN MYERS OTR/L

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
1	225X00000X	Occupational Therapist	OT 16665	FL
2	225X00000X	Occupational Therapist	OC013145	PA

General Provider Information

NPI Number	:	1669667119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY ANN MYERS OTR/L

Provider Business Mailing Address
First Line	:	2327 RIVERSIDE DR
Second Line	:
City	:	SOUTH WILLIAMSPORT
State	:	PA
Zip	:	17702-6834
Country	:	US
Telephone Number	:	570-447-3589
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N WEST SHORE BLVD
Second Line	:	SUITE 600
City	:	TAMPA
State	:	FL
Zip	:	33609-1140
Country	:	US
Telephone Number	:	813-469-1457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	12/09/2014

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