Basic Information
| Provider Information | |||||||||
| NPI: | 1477056737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | BETHANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4406 RAYMOND RD | ||||||||
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| City: | BEAVERTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486127103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104413736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3270 PRATT LAKE RD | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486248901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894267275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2018 | ||||||||
| LastUpdateDate: | 03/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201009554 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.