Provider Demographics
NPI:1225340607
Name:MORRISON, ANTOINETTE HUMPHREY (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:HUMPHREY
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FALLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1010
Mailing Address - Country:US
Mailing Address - Phone:570-574-1707
Mailing Address - Fax:
Practice Address - Street 1:27 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1010
Practice Address - Country:US
Practice Address - Phone:570-574-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03937225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist