Provider Demographics
NPI:1679922926
Name:MYERS, ANNETTE (OTR)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:OTR
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 146
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:IN
Mailing Address - Zip Code:47166-0146
Mailing Address - Country:US
Mailing Address - Phone:812-347-2159
Mailing Address - Fax:
Practice Address - Street 1:13201 MAGISTERIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4105
Practice Address - Country:US
Practice Address - Phone:502-244-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000591A225XP0019X
KYKY-R2365225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation