MEDICARE: KIMBERLY ANN MORGAN OTRL HTC PAM LLCC

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	225X00000X	Occupational Therapist	OT776	CA
2	225XE1200X	Ergonomics Occupational Therapist	OT776	CA
3	225XH1200X	Hand Occupational Therapist	OT776	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ05534Z	OTHER	CA	BS

General Provider Information

NPI Number	:	1891700191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN MORGAN OTRL HTC PAM LLCC

Provider Business Mailing Address
First Line	:	6692 MERCHANDISE WAY
Second Line	:	#C
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9453
Country	:	US
Telephone Number	:	530-621-1149
Fax Number	:	530-626-3049

Provider Business Practice Location Address
First Line	:	6692 MERCHANDISE WAY
Second Line	:	#C
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9453
Country	:	US
Telephone Number	:	530-621-1149
Fax Number	:	530-626-3049

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	04/18/2012

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