Provider Demographics
NPI:1881881720
Name:MYERS, EDWIN JAY (OTR/L, ATP)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:JAY
Last Name:MYERS
Suffix:
Gender:M
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 CULVER AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1328
Mailing Address - Country:US
Mailing Address - Phone:937-253-7656
Mailing Address - Fax:
Practice Address - Street 1:2216 CULVER AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1328
Practice Address - Country:US
Practice Address - Phone:937-253-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004251225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist