Provider Demographics
NPI:1396116166
Name:LITHERLAND, MERRETT
Entity type:Individual
Prefix:MR
First Name:MERRETT
Middle Name:
Last Name:LITHERLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 N WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2946
Mailing Address - Country:US
Mailing Address - Phone:314-965-3899
Mailing Address - Fax:
Practice Address - Street 1:848 N WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-2946
Practice Address - Country:US
Practice Address - Phone:314-965-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications