Provider Demographics
NPI:1265862353
Name:MEROLLIS, EMILY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MEROLLIS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 N FREMONT ST APT 17
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1186
Mailing Address - Country:US
Mailing Address - Phone:971-337-6372
Mailing Address - Fax:
Practice Address - Street 1:932 N FREMONT ST APT 17
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1186
Practice Address - Country:US
Practice Address - Phone:971-337-6372
Practice Address - Fax:503-914-1912
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR316739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265862353OtherOT NPI