Provider Demographics
NPI:1982172375
Name:MERLINO, ANNE EILEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:EILEEN
Last Name:MERLINO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-0092
Mailing Address - Country:US
Mailing Address - Phone:707-845-2717
Mailing Address - Fax:
Practice Address - Street 1:1245 OLD ARCATA RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6708
Practice Address - Country:US
Practice Address - Phone:707-826-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist