Provider Demographics
NPI:1437882503
Name:MERRILL, ALYSSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 BOX ELDER CIR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2865
Mailing Address - Country:US
Mailing Address - Phone:435-890-0560
Mailing Address - Fax:
Practice Address - Street 1:1570 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1006
Practice Address - Country:US
Practice Address - Phone:801-658-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12872355-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist