Provider Demographics
NPI:1710359435
Name:BLEDSOE, MORGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:HEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 W CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8414
Mailing Address - Country:US
Mailing Address - Phone:417-300-0909
Mailing Address - Fax:
Practice Address - Street 1:1717 W CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8414
Practice Address - Country:US
Practice Address - Phone:417-300-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026864225X00000X
AROTR3039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist