Provider Demographics
NPI:1366056731
Name:PROCTOR, MORGAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FOREST VIEW NURSING AND REHABILITATION
Mailing Address - Street 2:535 S. ELM STREET
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143
Mailing Address - Country:US
Mailing Address - Phone:630-773-9416
Mailing Address - Fax:
Practice Address - Street 1:WEST SUBURBAN NURSING AND REHABILITATION
Practice Address - Street 2:311 EDGEWATER DRIVE
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:630-984-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013600208100000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation