Healthcare Provider Details

I. General information

NPI: 1043880826
Provider Name (Legal Business Name): KILEY MARIE MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11051 N CUT RD
ROSCOMMON MI
48653-9340
US

IV. Provider business mailing address

1367 PIERCE RD
LUZERNE MI
48636-9729
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-9555
  • Fax:
Mailing address:
  • Phone: 906-440-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201011334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: