MEDICARE: MORGAN DAVIDSON

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	103TS0200X	School Psychologist	LSP.01406	OH

General Provider Information

NPI Number	:	1588597140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN DAVIDSON

Provider Business Mailing Address
First Line	:	3797 RIDGEWOOD RD
Second Line	:
City	:	COPLEY
State	:	OH
Zip	:	44321-1665
Country	:	US
Telephone Number	:	330-664-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3797 RIDGEWOOD RD
Second Line	:
City	:	COPLEY
State	:	OH
Zip	:	44321-1665
Country	:	US
Telephone Number	:	330-664-4800
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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