Individual
JEANESE MURDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
406 S MAIN ST, WINNSBORO, TX 75494-3226
(903) 342-6790
Mailing address
294 GADDY LN, GARRISON, TX 75946-7166
(936) 556-2855
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214732
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214732
COTA LICENSE
TX
Enumeration date
05/02/2018
Last updated
05/02/2018
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