Provider Demographics
NPI:1174004154
Name:FOWLER, MORGAN CECILE (COTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:CECILE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13470 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-8118
Mailing Address - Country:US
Mailing Address - Phone:870-370-2030
Mailing Address - Fax:
Practice Address - Street 1:6760 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:RISON
Practice Address - State:AR
Practice Address - Zip Code:71665-9031
Practice Address - Country:US
Practice Address - Phone:870-357-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1359224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty