Provider Demographics
NPI:1619730009
Name:GIBSON, MORGAN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 W GRAPEVINE MILLS CIR APT 5009
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2149
Mailing Address - Country:US
Mailing Address - Phone:254-485-8606
Mailing Address - Fax:
Practice Address - Street 1:2311 W GRAPEVINE MILLS CIR APT 5009
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2149
Practice Address - Country:US
Practice Address - Phone:254-485-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122797225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist