Healthcare Provider Details

I. General information

NPI: 1578971578
Provider Name (Legal Business Name): ALLISON MERRELL MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUND VALLEY DR
PARK CITY UT
84060-7552
US

IV. Provider business mailing address

900 ROUND VALLEY DR
PARK CITY UT
84060-7552
US

V. Phone/Fax

Practice location:
  • Phone: 435-657-4690
  • Fax:
Mailing address:
  • Phone: 435-658-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number80464043-4201
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number8046043-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: