Provider Demographics
NPI:1013484732
Name:JUDICE, MORGAN NICOLE PEDEN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:NICOLE PEDEN
Last Name:JUDICE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 KALAS CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-1172
Mailing Address - Country:US
Mailing Address - Phone:409-658-0961
Mailing Address - Fax:
Practice Address - Street 1:604 FM 1293 RD
Practice Address - Street 2:
Practice Address - City:KOUNTZE
Practice Address - State:TX
Practice Address - Zip Code:77625-7804
Practice Address - Country:US
Practice Address - Phone:409-658-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
214851224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214851OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS