Provider Demographics
NPI:1275141533
Name:MYERS, MEGAN ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BRIAN DR
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1651
Mailing Address - Country:US
Mailing Address - Phone:219-789-2987
Mailing Address - Fax:
Practice Address - Street 1:407 BRIAN DR
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1651
Practice Address - Country:US
Practice Address - Phone:219-789-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist