Provider Demographics
NPI:1942617428
Name:MERRILL, ALLEN LEE (ATC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:LEE
Last Name:MERRILL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 BENT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-8572
Mailing Address - Country:US
Mailing Address - Phone:864-237-8323
Mailing Address - Fax:
Practice Address - Street 1:269 BENT RIVER DR
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8572
Practice Address - Country:US
Practice Address - Phone:864-237-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer