Provider Demographics
NPI:1952186306
Name:MERRILL, TARA ANN (MS, CPO)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MS, CPO
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CPO
Mailing Address - Street 1:1345 WESTGATE CENTER DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3041
Mailing Address - Country:US
Mailing Address - Phone:336-546-7165
Mailing Address - Fax:866-403-2483
Practice Address - Street 1:1409 YANCEYVILLE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6961
Practice Address - Country:US
Practice Address - Phone:336-537-3901
Practice Address - Fax:336-893-9537
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist