Provider Demographics
NPI:1508497454
Name:MERO, ASHLYN BRIANNA (COTA)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:BRIANNA
Last Name:MERO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:BRIANNA
Other - Last Name:VANGINHOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:128 SOUTHWINDS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8678
Mailing Address - Country:US
Mailing Address - Phone:479-267-2777
Mailing Address - Fax:479-267-9011
Practice Address - Street 1:128 SOUTHWINDS RD STE 7
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8678
Practice Address - Country:US
Practice Address - Phone:479-267-2777
Practice Address - Fax:479-267-9011
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant