MEDICARE: MRS. KENNEDY MCCLAIN MORGAN OTD, OTR/L

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	225XP0200X	Pediatric Occupational Therapist	7734	TN

General Provider Information

NPI Number	:	1548941446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENNEDY MCCLAIN MORGAN OTD, OTR/L

Provider Business Mailing Address
First Line	:	1237 MURRAY CT
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-5630
Country	:	US
Telephone Number	:	615-504-7054
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 BABB DR
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2506
Country	:	US
Telephone Number	:	615-547-6008
Fax Number	:

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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