Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | T-03672 | KS |
NPI | 1003256454 |
---|---|
Provider Name | Mr. Richard Dewayne Morrison |
First Address | Iola, KS 66749-7062 |
Second Address | Iola, KS 66749-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2013 |
Last Update Date | 30/06/2013 |