MEDICARE: AUTUMN MURDOCH

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	235Z00000X	Speech-Language Pathologist	0989	WV

General Provider Information

NPI Number	:	1760846646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN MURDOCH

Provider Business Mailing Address
First Line	:	PO BOX 977
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-0977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CARRIAGE PT
Second Line	:	SUITE 202
City	:	HURRICANE
State	:	WV
Zip	:	25526-1526
Country	:	US
Telephone Number	:	304-634-4085
Fax Number	:

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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Directions to “ AUTUMN MURDOCH ” Practice Location

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