Provider Demographics
NPI:1700084647
Name:MERRIOTT, MADELINE (BACHELOR'S)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MERRIOTT
Suffix:
Gender:F
Credentials:BACHELOR'S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FALLING LEAF TER
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6756
Mailing Address - Country:US
Mailing Address - Phone:405-799-3379
Mailing Address - Fax:
Practice Address - Street 1:624 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3924
Practice Address - Country:US
Practice Address - Phone:405-912-3871
Practice Address - Fax:405-799-0912
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor