Provider Demographics
NPI:1801492665
Name:MCQUATER, MYLES STANDISH JR
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:STANDISH
Last Name:MCQUATER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5196 MARRUS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2976
Mailing Address - Country:US
Mailing Address - Phone:216-214-2869
Mailing Address - Fax:
Practice Address - Street 1:5196 MARRUS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2976
Practice Address - Country:US
Practice Address - Phone:216-214-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child