Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1013272277 |
---|---|
Provider Name | Timothy David Myers |
First Address | Sioux Falls, SD 57105-2129 |
Second Address | Sioux Falls, SD 57105-2129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 12/07/2012 |