MEDICARE: MRS. JESSICA E MCMURDIE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT00003453	WA

General Provider Information

NPI Number	:	1205811478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA E MCMURDIE OTR/L

Provider Business Mailing Address
First Line	:	1616 MONROE AVE NE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-3370
Country	:	US
Telephone Number	:	425-443-4831
Fax Number	:	425-793-0484

Provider Business Practice Location Address
First Line	:	1616 MONROE AVE NE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-3370
Country	:	US
Telephone Number	:	425-443-4831
Fax Number	:	425-793-0484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2005
Last Update Date	:	07/08/2007

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