Provider Demographics
NPI:1588194815
Name:LARSON, MORGAN MAE (ATC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:MAE
Last Name:LARSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40320 SD HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:FORESTBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57314-6424
Mailing Address - Country:US
Mailing Address - Phone:605-933-0485
Mailing Address - Fax:
Practice Address - Street 1:40320 SD HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:FORESTBURG
Practice Address - State:SD
Practice Address - Zip Code:57314-6424
Practice Address - Country:US
Practice Address - Phone:605-933-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20000282142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer