Provider Demographics
NPI:1679190128
Name:GRIMSLEY, MORGAN RYAN (MOT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RYAN
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-2381
Mailing Address - Country:US
Mailing Address - Phone:903-723-3602
Mailing Address - Fax:903-731-9573
Practice Address - Street 1:800 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2381
Practice Address - Country:US
Practice Address - Phone:903-723-3602
Practice Address - Fax:903-731-9573
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120623225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist