Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0119005944 | VA |
NPI | 1245617547 |
---|---|
Provider Name | Tara Murphy |
First Address | Fairfax, VA 22031-2504 |
Second Address | Fairfax, VA 22031-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336366079 | MEDICARE NPI (01) | VA |
1972592533 | MEDICARE NPI (01) | VA |