MEDICARE: JULIE MERINDA SMALL OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	5369	NC

General Provider Information

NPI Number	:	1427190313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MERINDA SMALL OTRL

Provider Business Mailing Address
First Line	:	205 GRAY RD
Second Line	:
City	:	NEWPORT
State	:	NC
Zip	:	28570-9237
Country	:	US
Telephone Number	:	252-675-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4218 ARENDELL ST
Second Line	:	SUITE M
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2866
Country	:	US
Telephone Number	:	252-808-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	01/05/2016

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