Active NPI
Jeanese Murdock
- Occupational Therapy Assistant
- Winnsboro, TX
National Provider Identifier
1780173088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 214732
- Practice address
- 406 S Main St
Winnsboro, TX 75494-3226 - Phone
- (903) 342-6790
- NPI assigned
- May 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 214732 | TX | Primary |
Addresses
Primary practice location
406 S Main St
Winnsboro, TX 75494-3226
Mailing address
294 Gaddy LN
Garrison, TX 75946-7166
Phone (936) 556-2855
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214732 | Other | TX | COTA LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 214732 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525219200000",
"number": "1780173088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "294 GADDY LN",
"city": "GARRISON",
"state": "TX",
"postal_code": "759467166",
"telephone_number": "936-556-2855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 S MAIN ST",
"city": "WINNSBORO",
"state": "TX",
"postal_code": "754943226",
"telephone_number": "903-342-6790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MURDOCK",
"first_name": "JEANESE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-02",
"last_updated": "2018-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "214732",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COTA LICENSE",
"identifier": "214732",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winnsboro, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.