Provider Demographics
NPI:1144000852
Name:MORRIS, KATHRYN MONICA (CRDH, OMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MONICA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CRDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 ERROL PKWY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2630
Mailing Address - Country:US
Mailing Address - Phone:772-919-2046
Mailing Address - Fax:
Practice Address - Street 1:1080 ERROL PKWY
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2630
Practice Address - Country:US
Practice Address - Phone:772-919-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH18599124Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No124Q00000XDental ProvidersDental Hygienist