Provider Demographics
NPI:1003038191
Name:MERYLE B. AXELROD
Entity Type:Organization
Organization Name:MERYLE B. AXELROD
Other - Org Name:PROFESSIONALLY YOURS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MERYLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:AXELROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-237-8884
Mailing Address - Street 1:167 ALMOND RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8629
Mailing Address - Country:US
Mailing Address - Phone:352-237-8884
Mailing Address - Fax:352-732-8884
Practice Address - Street 1:167 ALMOND RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8629
Practice Address - Country:US
Practice Address - Phone:352-237-8884
Practice Address - Fax:352-732-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681064196Medicaid
FL991874400Medicaid