MEDICARE: MORGAN LEE LAPRADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1386162170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN LEE LAPRADE

Provider Business Mailing Address
First Line	:	908 LORENZO DR
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-6618
Country	:	US
Telephone Number	:	434-221-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 LORENZO DR
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-6618
Country	:	US
Telephone Number	:	434-221-7019
Fax Number	:	434-221-7019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	09/01/2017

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