Provider Demographics
NPI:1083008452
Name:MORGAN, JENNIFER LYNN (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23823 MALIBU RD
Mailing Address - Street 2:SUITE 50 #242
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4628
Mailing Address - Country:US
Mailing Address - Phone:310-980-0601
Mailing Address - Fax:
Practice Address - Street 1:23823 MALIBU RD
Practice Address - Street 2:SUITE 50 #242
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4628
Practice Address - Country:US
Practice Address - Phone:310-980-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist