Basic Information
| Provider Information | |||||||||
| NPI: | 1538816137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | GWIN | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9101 WESLEYAN RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462683103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006006046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 ONE NINETEEN BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352427236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057454600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2022 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2175 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.