Provider Demographics
NPI:1093061475
Name:MERK, OLGA MARINA (LMT)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARINA
Last Name:MERK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 NW 87TH AVE
Mailing Address - Street 2:302
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3454
Mailing Address - Country:US
Mailing Address - Phone:305-670-0055
Mailing Address - Fax:305-670-0054
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-670-0055
Practice Address - Fax:305-670-0054
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist