Provider Demographics
NPI:1710384284
Name:ALDRICH, MORGAN ALISHA
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ALISHA
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1021
Mailing Address - Country:US
Mailing Address - Phone:262-758-1233
Mailing Address - Fax:
Practice Address - Street 1:501 LEWIS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1021
Practice Address - Country:US
Practice Address - Phone:262-758-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-29
Last Update Date:2014-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075811225X00000X
IL056.010817225X00000X
IN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist