Provider Demographics
NPI:1639208317
Name:MYERS, MOLLY RENAE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:RENAE
Last Name:MYERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MIKE CHAPA ST.
Mailing Address - Street 2:
Mailing Address - City:LA VILLA
Mailing Address - State:TX
Mailing Address - Zip Code:78562
Mailing Address - Country:US
Mailing Address - Phone:937-925-0333
Mailing Address - Fax:
Practice Address - Street 1:205 W SH 107
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1769
Practice Address - Country:US
Practice Address - Phone:956-262-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209909224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant