Provider Demographics
NPI:1649338047
Name:MERRILL, CHRISTINE HENRIE (OTR L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:HENRIE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HENRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:1160 N WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4932
Mailing Address - Country:US
Mailing Address - Phone:520-419-1059
Mailing Address - Fax:520-326-0318
Practice Address - Street 1:1160 N WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4932
Practice Address - Country:US
Practice Address - Phone:520-419-1059
Practice Address - Fax:520-326-0318
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ770629OtherAHCCCS MEDICAID