MEDICARE: MRS. JOLYNN S MUNRO 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	OT00001558	WA

General Provider Information

NPI Number	:	1578764270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOLYNN S MUNRO OTR

Provider Business Mailing Address
First Line	:	109 S MITCHELL CT
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9431
Country	:	US
Telephone Number	:	509-255-1222
Fax Number	:	509-255-1133

Provider Business Practice Location Address
First Line	:	109 S MITCHELL CT
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9431
Country	:	US
Telephone Number	:	509-255-1222
Fax Number	:	509-255-1133

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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