Provider Demographics
NPI:1467596601
Name:COLETTE ANN MYERS
Entity Type:Organization
Organization Name:COLETTE ANN MYERS
Other - Org Name:CAROLINA THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:919-489-3471
Mailing Address - Street 1:7 PITTSFORD PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5705
Mailing Address - Country:US
Mailing Address - Phone:919-489-3471
Mailing Address - Fax:919-489-3471
Practice Address - Street 1:7 PITTSFORD PL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5705
Practice Address - Country:US
Practice Address - Phone:919-489-3471
Practice Address - Fax:919-489-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210506Medicaid
NC7411399Medicaid