Provider Demographics
NPI:1558930420
Name:MERRITT, SUZANNE KENNERLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KENNERLY
Last Name:MERRITT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SHADDEN RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4233
Mailing Address - Country:US
Mailing Address - Phone:980-621-1042
Mailing Address - Fax:
Practice Address - Street 1:505 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4740
Practice Address - Country:US
Practice Address - Phone:980-621-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant