Provider Demographics
NPI:1861516635
Name:MYERS, JULIE (OT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WILLOW DRIVE, STE 100
Mailing Address - Street 2:WILLOWPOINTE PLAZA
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012
Mailing Address - Country:US
Mailing Address - Phone:724-379-7130
Mailing Address - Fax:724-379-7178
Practice Address - Street 1:800 WILLOW DRIVE, STE 100
Practice Address - Street 2:WILLOWPOINTE PLAZA
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:724-379-7130
Practice Address - Fax:724-379-7178
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005276L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016749970004Medicaid
PA0016749970004Medicaid