Provider Demographics
NPI:1750748026
Name:BECKLER, MYRA EILEEN SMITH
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:EILEEN SMITH
Last Name:BECKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MYRA
Other - Middle Name:SMITH
Other - Last Name:GUILARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:39 DAME KATHRYN DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-1603
Mailing Address - Country:US
Mailing Address - Phone:912-598-2740
Mailing Address - Fax:
Practice Address - Street 1:39 DAME KATHRYN DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-1603
Practice Address - Country:US
Practice Address - Phone:912-598-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist