MEDICARE: MRS. TARA ANN MERRILL MS, CPO

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	222Z00000X	Orthotist
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1952186306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA ANN MERRILL MS, CPO

Provider Business Mailing Address
First Line	:	1345 WESTGATE CENTER DRIVE
Second Line	:	SUITE B
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3041
Country	:	US
Telephone Number	:	336-546-7165
Fax Number	:	866-403-2483

Provider Business Practice Location Address
First Line	:	1409 YANCEYVILLE STREET
Second Line	:	SUITE B
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6961
Country	:	US
Telephone Number	:	336-537-3901
Fax Number	:	336-893-9537

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

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/28/2024

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