Provider Demographics
NPI:1144730623
Name:NIMS, MORGAN (OTRL)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:NIMS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 S 7TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2103
Mailing Address - Country:US
Mailing Address - Phone:315-247-6242
Mailing Address - Fax:
Practice Address - Street 1:4523 97TH AVE W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-1318
Practice Address - Country:US
Practice Address - Phone:253-566-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021935225X00000X
WAOT60834178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist