Provider Demographics
NPI:1861675100
Name:MYERS, JANE HELEN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:HELEN
Last Name:MYERS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2620
Mailing Address - Country:US
Mailing Address - Phone:770-641-9239
Mailing Address - Fax:770-641-9335
Practice Address - Street 1:345 RIDGE CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2620
Practice Address - Country:US
Practice Address - Phone:770-641-9239
Practice Address - Fax:770-641-9335
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004561225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist