Provider Demographics
NPI:1811458383
Name:MORGAN, THEODORE JR (COTA)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:MR
Other - First Name:TEDDY
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:1600 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 TEXAS ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3400
Practice Address - Country:US
Practice Address - Phone:817-338-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214175225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology