Provider Demographics
NPI:1154458677
Name:MYERS, ELIZABETH DIANE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2461 NOVA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3407
Mailing Address - Country:US
Mailing Address - Phone:513-252-1048
Mailing Address - Fax:
Practice Address - Street 1:2461 NOVA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3407
Practice Address - Country:US
Practice Address - Phone:513-252-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0020392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer