Healthcare Provider Details

I. General information

NPI: 1063411270
Provider Name (Legal Business Name): MS. BRIDGET LEE MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 GLEN ESTE WITHAMSVILLE RD
CINCINNATI OH
45245-1318
US

IV. Provider business mailing address

4701 CREEK RD SUITE 110
CINCINNATI OH
45242-8398
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-3630
  • Fax: 513-753-4308
Mailing address:
  • Phone: 513-733-9333
  • Fax: 513-588-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-001153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: