Healthcare Provider Details

I. General information

NPI: 1518218460
Provider Name (Legal Business Name): MERRITT R BLACK OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W STANFORD RANCH RD
ROCKLIN CA
95765-3811
US

IV. Provider business mailing address

5701 SKYRIDGE DR
ORANGEVALE CA
95662-5238
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-8020
  • Fax:
Mailing address:
  • Phone: 916-320-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: