Basic Information
| Provider Information | |||||||||
| NPI: | 1013381094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YEO | ||||||||
| OtherFirstName: | VIRGINIA | ||||||||
| OtherMiddleName: | BETH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | OTR/L, MIPH | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206502015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758981 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206502015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758981 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2015 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 07327 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT010000635 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.