Provider Demographics
NPI:1649406539
Name:MORGAN, DOUGLAS JR (PTA,OTA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:PTA,OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11610 LEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5024
Mailing Address - Country:US
Mailing Address - Phone:901-596-2256
Mailing Address - Fax:
Practice Address - Street 1:11610 LEEWOOD DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-5024
Practice Address - Country:US
Practice Address - Phone:901-596-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA1178224Z00000X
CAAT6722225200000X
TN1861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant