Healthcare Provider Details

I. General information

NPI: 1376477836
Provider Name (Legal Business Name): JESSICA MORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 92ND ST
MILWAUKEE WI
53226-3533
US

IV. Provider business mailing address

1000 N 92ND ST
MILWAUKEE WI
53226-3533
US

V. Phone/Fax

Practice location:
  • Phone: 414-259-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number9066-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: