Provider Demographics
NPI:1003174947
Name:MORRIS, GWEN RENEE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:RENEE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:RENEE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:SUITE 512
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-647-3110
Mailing Address - Fax:703-822-9955
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 512
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-647-3110
Practice Address - Fax:703-822-9955
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist