Provider Demographics
NPI:1003256454
Name:MORRISON, RICHARD DEWAYNE
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEWAYNE
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 5TH ST # GAS
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-7062
Mailing Address - Country:US
Mailing Address - Phone:620-363-1316
Mailing Address - Fax:
Practice Address - Street 1:101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3505
Practice Address - Country:US
Practice Address - Phone:620-365-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03672224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant