Provider Demographics
NPI:1811338965
Name:HAISLIP, MERRY CHRISTINE (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:MERRY
Middle Name:CHRISTINE
Last Name:HAISLIP
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 GREEN PARROT RD UNIT 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3299
Mailing Address - Country:US
Mailing Address - Phone:479-965-6786
Mailing Address - Fax:
Practice Address - Street 1:8210 GREEN PARROT RD UNIT 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3299
Practice Address - Country:US
Practice Address - Phone:479-965-6786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL33702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer