Provider Demographics
NPI:1598973562
Name:MERULLI, DESIREE A (LAC, EAMP, RYT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:MERULLI
Suffix:
Gender:F
Credentials:LAC, EAMP, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY STE 1658
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1729
Mailing Address - Country:US
Mailing Address - Phone:206-388-3349
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1658
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1729
Practice Address - Country:US
Practice Address - Phone:206-388-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011800225700000X
WAAC00001810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist