Provider Demographics
NPI:1316409220
Name:EMILY MEROLLIS CONSULTING LLC
Entity Type:Organization
Organization Name:EMILY MEROLLIS CONSULTING LLC
Other - Org Name:VIBRANCY PELVIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEROLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-337-6372
Mailing Address - Street 1:11 NE MARTIN LUTHER KING JR BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3579
Mailing Address - Country:US
Mailing Address - Phone:971-337-6372
Mailing Address - Fax:503-594-1222
Practice Address - Street 1:11 NE MARTIN LUTHER KING JR BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3579
Practice Address - Country:US
Practice Address - Phone:971-337-6372
Practice Address - Fax:503-594-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265862353OtherOT NPI
OR500765935Medicaid