Provider Demographics
NPI:1528396215
Name:MORRIS, JESSIE RACHEL SCOTT (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:RACHEL SCOTT
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 COVENTRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038
Mailing Address - Country:US
Mailing Address - Phone:920-342-3006
Mailing Address - Fax:
Practice Address - Street 1:5409 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1644
Practice Address - Country:US
Practice Address - Phone:414-232-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1027-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer