Provider Demographics
NPI:1083032460
Name:KELLEY, MORGAN UCCHINO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:UCCHINO
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5947 STILLSON PL
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2929
Mailing Address - Country:US
Mailing Address - Phone:330-540-2214
Mailing Address - Fax:
Practice Address - Street 1:38720 SALTWELL RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8303
Practice Address - Country:US
Practice Address - Phone:330-424-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.014413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist