Provider Demographics
NPI:1649444001
Name:MORGAN, IVANA AMORETTE (LMT)
Entity type:Individual
Prefix:MS
First Name:IVANA
Middle Name:AMORETTE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 LOCUST ST S
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9391
Mailing Address - Country:US
Mailing Address - Phone:330-564-7156
Mailing Address - Fax:330-753-0505
Practice Address - Street 1:2445 LOCUST ST S
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9391
Practice Address - Country:US
Practice Address - Phone:330-564-7156
Practice Address - Fax:330-753-0505
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014025225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist