Provider Demographics
NPI:1083331912
Name:SERRANO, MORGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5965 WILLOWYND DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3075
Mailing Address - Country:US
Mailing Address - Phone:573-225-6248
Mailing Address - Fax:
Practice Address - Street 1:5965 WILLOWYND DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3075
Practice Address - Country:US
Practice Address - Phone:573-225-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
388596OtherNBCOT
CA20655OtherCBOT