Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 104255 | MN |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5246-26 | WI |
NPI | 1093129223 |
---|---|
Provider Name | Molly Sue Morgel |
First Address | New Richmond, WI 54017-1467 |
Second Address | New Richmond, WI 54017-1467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 10/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104255 | STATE OT LICENSE (01) | MN |
5246-26 | STATE OT LICENSE (01) | WI |