Provider Demographics
NPI:1093032096
Name:AUSTIN, MYRA S (LRT/CTRS)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:S
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LRT/CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9087
Mailing Address - Country:US
Mailing Address - Phone:919-968-2073
Mailing Address - Fax:919-968-2093
Practice Address - Street 1:2551 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-9087
Practice Address - Country:US
Practice Address - Phone:919-968-2073
Practice Address - Fax:919-968-2093
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225800000X225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist