Provider Demographics
NPI:1598538514
Name:GILBERT, MORGAN WEAVER
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:WEAVER
Last Name:GILBERT
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 1:702 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:MARKED TREE
Mailing Address - State:AR
Mailing Address - Zip Code:72365-2706
Mailing Address - Country:US
Mailing Address - Phone:870-514-5127
Mailing Address - Fax:
Practice Address - Street 1:1028 N MISSOURI ST STE 5
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2600
Practice Address - Country:US
Practice Address - Phone:870-733-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2023-032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty