Provider Demographics
NPI:1811353220
Name:MYERS, MARK (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:424-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:184 DONALD LN
Practice Address - Street 2:SUITE 10
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2835
Practice Address - Country:US
Practice Address - Phone:814-266-1974
Practice Address - Fax:814-266-3407
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006563L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749Medicare PIN