Individual
MR. WILLIAM M MYERS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
1449 SUNNY LANE RD, BENTON, MS 39039-9400
(662) 571-2464
Mailing address
1449 SUNNY LANE RD, BENTON, MS 39039-9400
(662) 571-2464
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
TA2243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TA2243
COTA/L
MS
Enumeration date
02/26/2011
Last updated
02/26/2011
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