Provider Demographics
NPI:1245633999
Name:MERRITT, MOLLIE (ATC/ L)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:ATC/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-2852
Mailing Address - Country:US
Mailing Address - Phone:828-464-3771
Mailing Address - Fax:
Practice Address - Street 1:4090 CHASEWOOD DR
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-7557
Practice Address - Country:US
Practice Address - Phone:828-455-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist