Provider Demographics
NPI:1992680912
Name:MERRYMAN, MICHELLE LEE (BA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:MERRYMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 OZARKA COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6455
Mailing Address - Country:US
Mailing Address - Phone:870-269-2110
Mailing Address - Fax:
Practice Address - Street 1:1810 OZARKA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6455
Practice Address - Country:US
Practice Address - Phone:870-269-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist