Healthcare Provider Details

I. General information

NPI: 1477159697
Provider Name (Legal Business Name): MORGAN RAE MANSUR MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 GRAVOIS RD
HIGH RIDGE MO
63049-2606
US

IV. Provider business mailing address

PO BOX 271
HIGH RIDGE MO
63049-0271
US

V. Phone/Fax

Practice location:
  • Phone: 636-534-0228
  • Fax: 636-534-0195
Mailing address:
  • Phone: 636-534-0228
  • Fax: 636-534-0195

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: