Provider Demographics
NPI:1760656813
Name:MORRIS, MIRANDA MARIE
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:MARIE
Last Name:MORRIS
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 1:10 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-9209
Mailing Address - Country:US
Mailing Address - Phone:217-498-6924
Mailing Address - Fax:
Practice Address - Street 1:10 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-9209
Practice Address - Country:US
Practice Address - Phone:217-498-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist