Provider Demographics
NPI:1437661410
Name:MYERSCOUGH, METAJEAN (BCTMB)
Entity Type:Individual
Prefix:
First Name:METAJEAN
Middle Name:
Last Name:MYERSCOUGH
Suffix:
Gender:F
Credentials:BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08344-0771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 N WEST BLVD FL 2
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08344-9556
Practice Address - Country:US
Practice Address - Phone:856-212-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA87716225700000X
NJ18KT01114400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist