Provider Demographics
NPI:1497950562
Name:MYERS, KRISTIN KELLY (OTA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:KELLY
Last Name:MYERS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 CRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1838
Mailing Address - Country:US
Mailing Address - Phone:319-981-4038
Mailing Address - Fax:
Practice Address - Street 1:3661 ROCHESTER AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9271
Practice Address - Country:US
Practice Address - Phone:319-351-7460
Practice Address - Fax:319-341-6229
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00692224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant