Provider Demographics
NPI:1184190860
Name:STATON, MORGAN O (MS, OTR/L, FMACP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:O
Last Name:STATON
Suffix:
Gender:F
Credentials:MS, OTR/L, FMACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 MIDDLEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1160
Mailing Address - Country:US
Mailing Address - Phone:419-366-9987
Mailing Address - Fax:
Practice Address - Street 1:4386 MIDDLEDALE AVE
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1160
Practice Address - Country:US
Practice Address - Phone:419-366-9987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010303225X00000X
171400000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist