Provider Demographics
NPI:1326138454
Name:MERZOIAN, MICHELLE M (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:MERZOIAN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:1230 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3166
Mailing Address - Country:US
Mailing Address - Phone:360-575-4855
Mailing Address - Fax:360-636-6282
Practice Address - Street 1:1230 7TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3166
Practice Address - Country:US
Practice Address - Phone:360-575-4855
Practice Address - Fax:360-636-6282
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7683261Medicaid
WA0154956OtherLABOR & INDUSTRIES
WA0154956OtherLABOR & INDUSTRIES