Provider Demographics
NPI:1093129223
Name:MORGEL, MOLLY SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:SUE
Last Name:MORGEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1467
Mailing Address - Country:US
Mailing Address - Phone:715-243-3900
Mailing Address - Fax:
Practice Address - Street 1:1127 W 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1467
Practice Address - Country:US
Practice Address - Phone:715-243-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104255225X00000X
WI5246-26225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5246-26OtherSTATE OT LICENSE
MN104255OtherSTATE OT LICENSE