Healthcare Provider Details

I. General information

NPI: 1316429921
Provider Name (Legal Business Name): BENJAMIN PATRICK MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S COMMONWEALTH AVE
CORBIN KY
40701-6408
US

IV. Provider business mailing address

116 S COMMONWEALTH AVE
CORBIN KY
40701-6408
US

V. Phone/Fax

Practice location:
  • Phone: 606-258-2525
  • Fax: 606-528-3916
Mailing address:
  • Phone: 606-258-2525
  • Fax: 606-528-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number132675
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: