Provider Demographics
NPI:1508934159
Name:MERRILL, EMILY ALDEN (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ALDEN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14738 LIONS PRIDE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3935
Mailing Address - Country:US
Mailing Address - Phone:704-361-8184
Mailing Address - Fax:980-343-3803
Practice Address - Street 1:4301 SANDY PORTER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3214
Practice Address - Country:US
Practice Address - Phone:980-343-3800
Practice Address - Fax:980-343-3803
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer