Provider Demographics
NPI:1740549732
Name:MORRISON, TARA NICOLE (COTA/L)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:THRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5818 SANDSHELL CIR W APT 23103
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-7040
Mailing Address - Country:US
Mailing Address - Phone:575-607-5486
Mailing Address - Fax:
Practice Address - Street 1:200 COUNTRY BROOK DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2125
Practice Address - Country:US
Practice Address - Phone:682-593-2742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213786224Z00000X
FLOTA 13887224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant