Healthcare Provider Details

I. General information

NPI: 1235776493
Provider Name (Legal Business Name): DEVIN REID MERKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 DARWIN AVE APT 8
LOGAN UT
84321-6119
US

IV. Provider business mailing address

358 S 700 E STE B307
SALT LAKE CITY UT
84102-2161
US

V. Phone/Fax

Practice location:
  • Phone: 385-626-1861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: