Healthcare Provider Details

I. General information

NPI: 1124158241
Provider Name (Legal Business Name): MARILYN MORGAN OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4 WESTMINISTER STREET
SAXTONS RIVER VT
05154-0215
US

IV. Provider business mailing address

PO BOX 215 4 WESTMINISTER ST
SAXTONS RIVER VT
05154-0215
US

V. Phone/Fax

Practice location:
  • Phone: 802-869-1195
  • Fax:
Mailing address:
  • Phone: 802-869-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000032
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: