Basic Information
| Provider Information | |||||||||
| NPI: | 1184650715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRIFIELD | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 POTTERY AVE | ||||||||
| Address2: | APT. 120 | ||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983662051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655888591 | ||||||||
| FaxNumber: | 8655584481 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 POTTERY AVE | ||||||||
| Address2: | APT. 120 | ||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983662051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655888591 | ||||||||
| FaxNumber: | 8655584481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT0000000186 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.