Provider Demographics
NPI:1326923970
Name:MORTON, KALLI SELMA
Entity type:Individual
Prefix:
First Name:KALLI
Middle Name:SELMA
Last Name:MORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 HARVEST MOON DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3563
Mailing Address - Country:US
Mailing Address - Phone:920-527-9696
Mailing Address - Fax:
Practice Address - Street 1:1371 HARVEST MOON DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3563
Practice Address - Country:US
Practice Address - Phone:920-527-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7249224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant