Provider Demographics
NPI:1639539190
Name:MORRIS, MOLLY (OTA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N EL PASO AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3418
Mailing Address - Country:US
Mailing Address - Phone:501-681-8774
Mailing Address - Fax:479-495-2622
Practice Address - Street 1:10668 LYDIA LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833-6890
Practice Address - Country:US
Practice Address - Phone:479-495-0651
Practice Address - Fax:479-495-2622
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1043224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant