MEDICARE: EMILY MEROLLIS MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	316739	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265862353	OTHER		OT NPI

General Provider Information

NPI Number	:	1265862353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MEROLLIS MOTR/L

Provider Business Mailing Address
First Line	:	2444 SW 87TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-4006
Country	:	US
Telephone Number	:	971-337-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 NE MLK JR BLVD STE 202
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3579
Country	:	US
Telephone Number	:	971-337-6372
Fax Number	:	503-594-1222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	12/16/2025

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Directions to “ EMILY MEROLLIS MOTR/L” Practice Location

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