Provider Demographics
NPI:1033640578
Name:GRAHAM, MORGAN KATHLEEN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:KATHLEEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:KATHLEEN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2433 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2731
Mailing Address - Country:US
Mailing Address - Phone:608-302-9906
Mailing Address - Fax:
Practice Address - Street 1:557 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2907
Practice Address - Country:US
Practice Address - Phone:608-754-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer