MEDICARE: MORGAN ALYSSA TABOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295252641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN ALYSSA TABOR

Provider Business Mailing Address
First Line	:	16542 RUBY MEADOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-4986
Country	:	US
Telephone Number	:	713-319-6351
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 PEARL ST APT 508
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-5157
Country	:	US
Telephone Number	:	713-319-6351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	08/26/2017

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