Healthcare Provider Details

I. General information

NPI: 1396279899
Provider Name (Legal Business Name): ELLEN MORRIS MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FARRIS PARKS BLVD
RICHMOND KY
40475-7650
US

IV. Provider business mailing address

4161 VICTORIA WAY APT 17206
LEXINGTON KY
40515-4835
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-3666
  • Fax:
Mailing address:
  • Phone: 802-324-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number251769
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: