Provider Demographics
NPI:1639207848
Name:MURPHY, LISA DAWN (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 N STATE HIGHWAY CC
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8015
Mailing Address - Country:US
Mailing Address - Phone:417-725-5774
Mailing Address - Fax:417-725-5915
Practice Address - Street 1:1887 N STATE HIGHWAY CC
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8015
Practice Address - Country:US
Practice Address - Phone:417-725-5774
Practice Address - Fax:417-725-5915
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002053225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000027117Medicare ID - Type Unspecified