Provider Demographics
NPI:1669927281
Name:JUNCKER, MORGAN (LOTR)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:JUNCKER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4222
Mailing Address - Country:US
Mailing Address - Phone:504-828-7696
Mailing Address - Fax:
Practice Address - Street 1:8300 EARHART BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4428
Practice Address - Country:US
Practice Address - Phone:504-866-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist