Provider Demographics
NPI:1730245440
Name:MORELLO, NILKA D (OTR)
Entity type:Individual
Prefix:MS
First Name:NILKA
Middle Name:D
Last Name:MORELLO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-1823
Mailing Address - Country:US
Mailing Address - Phone:706-595-9445
Mailing Address - Fax:706-595-0029
Practice Address - Street 1:431 WEST HILL STREET
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-1823
Practice Address - Country:US
Practice Address - Phone:706-595-9445
Practice Address - Fax:706-595-0029
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q51788Medicare UPIN
GA67BBBMKMedicare ID - Type Unspecified