Provider Demographics
NPI:1619983574
Name:MORRIS, ROBERTA (OTRL CHT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1743
Mailing Address - Country:US
Mailing Address - Phone:610-651-8282
Mailing Address - Fax:610-651-8213
Practice Address - Street 1:250 WEST LANCASTER AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-651-8282
Practice Address - Fax:610-651-8213
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001118L225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
050529947OtherSMART COMP
3207843OtherAETNA PPO
050529947OtherFIRST HEALTH
2116418000OtherKEYSTONE HPE
050529947OtherUNITED HEALTHCARE
P00122385OtherMEDICARE RAILROAD
050529947OtherPRIVATE HEALTHCARE SYSTEM
050529947OtherDEVON HEALTH SYSTEMS
050529947OtherINTERGROUP
2116515000OtherPERSONAL CHOICE
050529947OtherFIRST HEALTH
PA4782050001Medicare NSC
050529947OtherINTERGROUP