Provider Demographics
NPI:1477316701
Name:DICKERSON, MORGAN LACEY
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LACEY
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LACEY
Other - Last Name:DYKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1544
Mailing Address - Country:US
Mailing Address - Phone:308-250-3482
Mailing Address - Fax:
Practice Address - Street 1:255 W 4TH ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1706
Practice Address - Country:US
Practice Address - Phone:308-235-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2571225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist