Provider Demographics
NPI:1063470318
Name:MERRILL ENTERPRISES, INC
Entity Type:Organization
Organization Name:MERRILL ENTERPRISES, INC
Other - Org Name:PRESCOTT PEDIATRIC OCCUPATIONAL THERAPY; SECOND SIGHT VISION REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:928-771-2406
Mailing Address - Street 1:512 W LEROUX ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4126
Mailing Address - Country:US
Mailing Address - Phone:928-771-2406
Mailing Address - Fax:928-771-9017
Practice Address - Street 1:340 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2620
Practice Address - Country:US
Practice Address - Phone:928-771-2406
Practice Address - Fax:928-771-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0295630OtherBLUE CROSS #
AZ770629OtherAHCCCS #
AZZ64797Medicare ID - Type Unspecified