Healthcare Provider Details

I. General information

NPI: 1649398991
Provider Name (Legal Business Name): ROBIN RAMONA MORSE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 S CAMPBELL AVE STE.107
SPRINGFIELD MO
65810-2512
US

IV. Provider business mailing address

710 S RIDGECREST AVE
NIXA MO
65714-7803
US

V. Phone/Fax

Practice location:
  • Phone: 417-496-8295
  • Fax:
Mailing address:
  • Phone: 417-496-8295
  • Fax: 417-424-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2004021693
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: