Provider Demographics
NPI:1407397482
Name:MYERS, OLIVIA (OTRL)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5270
Mailing Address - Country:US
Mailing Address - Phone:586-623-0331
Mailing Address - Fax:
Practice Address - Street 1:16260 PARK LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-9480
Practice Address - Country:US
Practice Address - Phone:517-339-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist