Healthcare Provider Details

I. General information

NPI: 1538997077
Provider Name (Legal Business Name): MORGAN TAYLOR VAN AUSDAL MSOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10539 PROFESSIONAL CIR STE 201
RENO NV
89521-3858
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-8800
  • Fax: 480-499-8459
Mailing address:
  • Phone: 623-241-8741
  • Fax: 484-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3180
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2505
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: