Provider Demographics
NPI:1073760401
Name:MORGAN, KELLY SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-5173
Mailing Address - Country:US
Mailing Address - Phone:901-428-8011
Mailing Address - Fax:
Practice Address - Street 1:6270 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-5173
Practice Address - Country:US
Practice Address - Phone:901-428-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist