Healthcare Provider Details

I. General information

NPI: 1386512747
Provider Name (Legal Business Name): MITZI ANN MERRILL X OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR RD
MARTINEZ CA
94553-4672
US

IV. Provider business mailing address

430 MERRITT AVE APT 201
OAKLAND CA
94610-5100
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-4520
  • Fax:
Mailing address:
  • Phone: 925-313-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: