Healthcare Provider Details

I. General information

NPI: 1184580342
Provider Name (Legal Business Name): JENEAL MARIE MERRIMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 S VAL VISTA DR STE 201
GILBERT AZ
85295-5594
US

IV. Provider business mailing address

8750 E FAIRBROOK ST
MESA AZ
85207-5004
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-3966
  • Fax:
Mailing address:
  • Phone: 623-263-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010282
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: