Provider Demographics
NPI:1861419947
Name:MORNINGSTAR, LAURA ANN (ATC, CES, MSA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:MORNINGSTAR
Suffix:
Gender:F
Credentials:ATC, CES, MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2323
Mailing Address - Country:US
Mailing Address - Phone:573-986-4444
Mailing Address - Fax:573-339-7125
Practice Address - Street 1:2126 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5826
Practice Address - Country:US
Practice Address - Phone:573-986-4444
Practice Address - Fax:573-339-7125
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030175332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer