Healthcare Provider Details

I. General information

NPI: 1669097309
Provider Name (Legal Business Name): NATALIE ANN MERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40374 FREMONT BLVD UNIT C
FREMONT CA
94538-3409
US

IV. Provider business mailing address

1875 S GENEVA RD
OREM UT
84058-2217
US

V. Phone/Fax

Practice location:
  • Phone: 510-315-5257
  • Fax:
Mailing address:
  • Phone: 801-437-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14270093-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: