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General NPI Number Information
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NPI Number | 1881724011
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Entity Type | Individual
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Provider Name | PENELOPE MORISEY OTR
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 645 EVENING PINE LN
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City | ALPHARETTA
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State | GA
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Zip | 30005-7417
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Country | US
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Telephone | 770-667-5792
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 LAKEWAY PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-2415
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Country | US
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Telephone | 770-667-5792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT002054
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License Number State | GA
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