1316409220 NPI number — EMILY MEROLLIS CONSULTING LLC

Table of content: (NPI 1316409220)

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:
VIBRANCY PELVIC HEALTH
Provider Other Organization Name Type Code:
3
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".