MEDICARE: TABATHA MERRIMAN

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1861114720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABATHA MERRIMAN

Provider Business Mailing Address
First Line	:	2511 RIDGE OAK LN APT 2112
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2902
Country	:	US
Telephone Number	:	214-245-7636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2511 RIDGE OAK LN APT 2112
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2902
Country	:	US
Telephone Number	:	214-245-7636
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	10/19/2022

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Directions to “ TABATHA MERRIMAN ” Practice Location

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