Healthcare Provider Details

I. General information

NPI: 1124882626
Provider Name (Legal Business Name): MORGAN FULLER MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN LEACH MOT, OTR/L

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1181 KA UKA BLVD STE C
WAIPAHU HI
96797-4485
US

IV. Provider business mailing address

95-009 KAHOEA ST APT 123
MILILANI HI
96789-1556
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9056
  • Fax:
Mailing address:
  • Phone: 757-650-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119006687
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2481
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: