Provider Demographics
NPI:1124187158
Name:MORRA, STEPHEN GERARD (MSOTR L)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GERARD
Last Name:MORRA
Suffix:
Gender:M
Credentials:MSOTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8462
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-8462
Mailing Address - Country:US
Mailing Address - Phone:858-218-4844
Mailing Address - Fax:
Practice Address - Street 1:151 PIONEER LANE
Practice Address - Street 2:BISHOP CARE CENTER
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514
Practice Address - Country:US
Practice Address - Phone:760-872-1000
Practice Address - Fax:760-872-1643
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist