Provider Demographics
NPI:1437538436
Name:MCMURRIAN, TYESHA RAENETT (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TYESHA
Middle Name:RAENETT
Last Name:MCMURRIAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 SUMMER CREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-9782
Mailing Address - Country:US
Mailing Address - Phone:325-947-8776
Mailing Address - Fax:
Practice Address - Street 1:3745 SUMMER CREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-9782
Practice Address - Country:US
Practice Address - Phone:325-947-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210727224Z00000X
AROT-A446224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant