Healthcare Provider Details

I. General information

NPI: 1720658982
Provider Name (Legal Business Name): MORGAN NICOLE EKSTROM OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN NICOLE STROM

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 ANDERSON HEALTHCARE DR
EDWARDSVILLE IL
62025-7712
US

IV. Provider business mailing address

405 E ALTON ST
MARINE IL
62061-1401
US

V. Phone/Fax

Practice location:
  • Phone: 618-307-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: