Morgan Rae Lidy
Individual provider Active NPI Developmental Therapist · Dieterich, IL
NPI 1164026662 · NPPES record last updated Nov 24, 2020
Key facts
- NPI
- 1164026662
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- Practice address
- 208 S Main St
Dieterich, IL 62424-1123 - Phone
- (217) 821-7694
- NPI assigned
- Nov 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist |
222Q00000X | Yes |
Addresses
Primary practice location
208 S Main St
Dieterich, IL 62424-1123
Mailing address
208 S Main St
Dieterich, IL 62424-1123
Other providers in Dieterich, IL
- Jennifer Tinsley Pmhnp-BC, PLLC
- Kristen Rose Kennedy
- Jennifer Elizabeth Kistner
- Debra Kitten
- Angela Koester
- Julie Marie Loy
- Mid-Illinois Medical Care Associates, LLC
- Morgan Michelle Repking
- Michelle Schnepper
- Stephanie Shadle
All providers in Dieterich, IL · Developmental Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.