1316409220 NPI number — EMILY MEROLLIS CONSULTING LLC

Table of content: DR. DONNA MARIE PIETROCOLA M.D. (NPI 1407841679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316409220 NPI number — EMILY MEROLLIS CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMILY MEROLLIS CONSULTING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316409220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 NE MARTIN LUTHER KING JR BLVD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97232-3579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-337-6372
Provider Business Mailing Address Fax Number:
503-594-1222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 NE MARTIN LUTHER KING JR BLVD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97232-3579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-337-6372
Provider Business Practice Location Address Fax Number:
503-594-1222
Provider Enumeration Date:
04/01/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEROLLIS
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
971-337-6372

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1265862353 . This is a "OT NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500765935 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".