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General NPI Number Information
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NPI Number | 1407142565
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Entity Type | Individual
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Provider Name | SUSAN LIZABETH MERRITT OT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 555 RANCH ROAD 3237
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City | WIMBERLEY
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State | TX
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Zip | 78676-5311
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Country | US
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Telephone | 512-847-5540
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Fax | 512-847-0419
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Provider Business Mailing Address
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Address Line | 6 STONEHOUSE CIR
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City | WIMBERLEY
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State | TX
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Zip | 78676-2704
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Country | US
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Telephone | 512-847-8538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 106610
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License Number State | TX
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