Provider Demographics
NPI:1104370196
Name:MYERS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 W 97TH ST
Mailing Address - Street 2:APT 204
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3365
Mailing Address - Country:US
Mailing Address - Phone:773-610-9020
Mailing Address - Fax:
Practice Address - Street 1:4030 W 97TH ST
Practice Address - Street 2:APT 204
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3365
Practice Address - Country:US
Practice Address - Phone:773-610-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011546225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist