MEDICARE: RONALD MORRIS

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	224Z00000X	Occupational Therapy Assistant	2012016605	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2012016605	OTHER	MO	MEDICARE

General Provider Information

NPI Number	:	1982941696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD MORRIS

Provider Business Mailing Address
First Line	:	3119 CENTRAL ST APT A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1359
Country	:	US
Telephone Number	:	915-494-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	3119 CENTRAL ST APT A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1359
Country	:	US
Telephone Number	:	915-494-0802
Fax Number	:

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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