Provider Demographics
NPI:1801236963
Name:MYERS, DARLENE (COTA/L)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1229 W CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-2417
Mailing Address - Country:US
Mailing Address - Phone:804-405-0663
Mailing Address - Fax:
Practice Address - Street 1:1229 W CHAPEL DR
Practice Address - Street 2:
Practice Address - City:BUMPASS
Practice Address - State:VA
Practice Address - Zip Code:23024-2417
Practice Address - Country:US
Practice Address - Phone:804-405-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000665208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation