Provider Demographics
NPI:1114382959
Name:BODE, MORGAN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BODE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MORGAN
Other - Middle Name:NICOLE
Other - Last Name:SYVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:505 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-5111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-5111
Practice Address - Country:US
Practice Address - Phone:712-368-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000999224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant