Healthcare Provider Details

I. General information

NPI: 1760460455
Provider Name (Legal Business Name): MORGAN J MILLER MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 S NOLAND RD
INDEPENDENCE MO
64055-4743
US

IV. Provider business mailing address

4401 S LIBERTY AVE APT. 5
INDEPENDENCE MO
64055-7316
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-2845
  • Fax: 816-373-2842
Mailing address:
  • Phone: 816-350-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2005034474
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: