Provider Demographics
NPI:1447845367
Name:MERKULOV, VLADISLAV (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:VLADISLAV
Middle Name:
Last Name:MERKULOV
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15942 E OTERO CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4761
Mailing Address - Country:US
Mailing Address - Phone:720-935-2713
Mailing Address - Fax:
Practice Address - Street 1:15942 E OTERO CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4761
Practice Address - Country:US
Practice Address - Phone:720-935-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist