MEDICARE: MRS. MORGAN LEAH BACKES OTR

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	31006158A	IN

General Provider Information

NPI Number	:	1982159976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MORGAN LEAH BACKES OTR

Provider Business Mailing Address
First Line	:	6437 RUCKER RD STE D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4868
Country	:	US
Telephone Number	:	317-405-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	6437 RUCKER RD STE D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4868
Country	:	US
Telephone Number	:	317-405-9016
Fax Number	:

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	02/07/2020

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