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NPI Code Detail

MEDICARE: TYLER CHRISTOPHER MERRILL

MEDICARE: TYLER CHRISTOPHER MERRILL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1952176109
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER CHRISTOPHER MERRILL
Provider Business Mailing Address
First Line : 1326 PINEWOOD TRL
Second Line :
City : NEW RICHMOND
State : WI
Zip : 54017-6361
Country : US
Telephone Number : 909-257-6624
Fax Number :
Provider Business Practice Location Address
First Line : 3111 124TH AVE NW STE 150
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-4581
Country : US
Telephone Number : 763-272-5877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2023
Last Update Date : 11/17/2023

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Directions to “ TYLER CHRISTOPHER MERRILL ” Practice Location

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