Provider Demographics
NPI:1194378166
Name:MYERS, MARCI RAY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:RAY
Last Name:MYERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:MARCI
Other - Middle Name:RAY
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3911 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1516
Mailing Address - Country:US
Mailing Address - Phone:417-846-5392
Mailing Address - Fax:
Practice Address - Street 1:2403 MARYLANE DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6702
Practice Address - Country:US
Practice Address - Phone:479-790-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005318224Z00000X
AROT-A1493224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant