Provider Demographics
NPI:1497251250
Name:MERKABA
Entity Type:Organization
Organization Name:MERKABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARY LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-251-9171
Mailing Address - Street 1:9221 E BASELINE RD STE A109-617
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8379
Mailing Address - Country:US
Mailing Address - Phone:480-251-9171
Mailing Address - Fax:480-357-4639
Practice Address - Street 1:3984 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1461
Practice Address - Country:US
Practice Address - Phone:480-251-9171
Practice Address - Fax:480-357-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty