Healthcare Provider Details

I. General information

NPI: 1871456707
Provider Name (Legal Business Name): KATIE L. MERRILL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GRANVIEW DR
BARRE VT
05641-5113
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-479-2502
  • Fax: 802-479-4056
Mailing address:
  • Phone: 802-479-2502
  • Fax: 802-479-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136050
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: