Provider Demographics
NPI:1649417197
Name:JENKINS, MURIAH LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MURIAH
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:MURIAH
Other - Middle Name:LYNN
Other - Last Name:LETTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:363 ROUTE WW
Mailing Address - Street 2:
Mailing Address - City:SOUTH GREENFLD
Mailing Address - State:MO
Mailing Address - Zip Code:65752
Mailing Address - Country:US
Mailing Address - Phone:417-619-6081
Mailing Address - Fax:
Practice Address - Street 1:363 ROUTE WW
Practice Address - Street 2:
Practice Address - City:SOUTH GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65752-7167
Practice Address - Country:US
Practice Address - Phone:417-452-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017410224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant