Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 113477 | TX |
NPI | 1003126889 |
---|---|
Provider Name | Miss Jessica Marie Murphy |
First Address | Brownsville, TX 78520-7559 |
Second Address | Brownsville, TX 78520-7559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2010 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
169033101 | (05) | TX |
45-4849 | MEDICARE (01) | TX |