Provider Demographics
NPI:1073238473
Name:MERTAUGH, MERISSA (LMT, MLD-C)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:
Last Name:MERTAUGH
Suffix:
Gender:F
Credentials:LMT, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CLEARWATER DR UNIT 149
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1365
Mailing Address - Country:US
Mailing Address - Phone:207-899-5334
Mailing Address - Fax:
Practice Address - Street 1:690 STROUDWATER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4949
Practice Address - Country:US
Practice Address - Phone:207-899-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty