Provider Demographics
NPI:1285002972
Name:MORDEN, KORI (OT)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:MORDEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:LEE
Other - Last Name:WANLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3228 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356-1684
Mailing Address - Country:US
Mailing Address - Phone:810-252-9044
Mailing Address - Fax:
Practice Address - Street 1:3875 GOLFSIDE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3726
Practice Address - Country:US
Practice Address - Phone:734-572-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist