Provider Demographics
NPI:1083349575
Name:MEHRL, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:MEHRL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7086
Mailing Address - Country:US
Mailing Address - Phone:515-210-8713
Mailing Address - Fax:
Practice Address - Street 1:1401 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6500
Practice Address - Country:US
Practice Address - Phone:515-381-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278766225X00000X
IA097034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist