Provider Demographics
NPI:1730741026
Name:CHA, MYKER YANG
Entity type:Individual
Prefix:
First Name:MYKER
Middle Name:YANG
Last Name:CHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S BRYAN AVE APT H805
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-1114
Mailing Address - Country:US
Mailing Address - Phone:952-818-7616
Mailing Address - Fax:
Practice Address - Street 1:NORTH PLATTE CARE CENTER
Practice Address - Street 2:2900 W E ST
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-1803
Practice Address - Country:US
Practice Address - Phone:308-534-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE962224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant