Healthcare Provider Details

I. General information

NPI: 1952186306
Provider Name (Legal Business Name): TARA ANN MERRILL MS, CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA ANN ROY MS, CPO

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/28/2024
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 YANCEYVILLE STREET SUITE B
GREENSBORO NC
27405-6961
US

IV. Provider business mailing address

1345 WESTGATE CENTER DRIVE SUITE B
WINSTON SALEM NC
27103-3041
US

V. Phone/Fax

Practice location:
  • Phone: 336-537-3901
  • Fax: 336-893-9537
Mailing address:
  • Phone: 336-546-7165
  • Fax: 866-403-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: