Provider Demographics
NPI:1538456488
Name:MERRICK, WILLIAM C JR (LMP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:MERRICK
Suffix:JR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:22500 NE MARKETPLACE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2033
Practice Address - Country:US
Practice Address - Phone:425-836-1034
Practice Address - Fax:425-361-1037
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMA60110223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0280893OtherL & I