MEDICARE: EMILY SHANNON MURRAY OTR

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	225X00000X	Occupational Therapist
2	225X00000X	Occupational Therapist	056.013260	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	821602865	OTHER	IL	M STREET PEDIATRIC THERAPY

General Provider Information

NPI Number	:	1427607860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SHANNON MURRAY OTR

Provider Business Mailing Address
First Line	:	1311 MAMARONECK AVE STE 140
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5224
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-580-5222

Provider Business Practice Location Address
First Line	:	1850 JOHNS DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-1657
Country	:	US
Telephone Number	:	847-707-6744
Fax Number	:	847-786-2156

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

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	10/07/2021

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