Provider Demographics
NPI:1538997077
Name:VAN AUSDAL, MORGAN TAYLOR (MSOT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:TAYLOR
Last Name:VAN AUSDAL
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4723
Mailing Address - Country:US
Mailing Address - Phone:775-786-3040
Mailing Address - Fax:775-788-1887
Practice Address - Street 1:1365 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4653
Practice Address - Country:US
Practice Address - Phone:775-786-3040
Practice Address - Fax:775-788-5254
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2505225X00000X
NV3180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16510196OtherCAQH
NV250038640Medicaid