Provider Demographics
NPI:1134332489
Name:MURRAY, JESSICA MARIE (OTR)
Entity type:Individual
Prefix:MR
First Name:JESSICA
Middle Name:MARIE
Last Name:MURRAY
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:13667-0002
Mailing Address - Country:US
Mailing Address - Phone:315-244-3892
Mailing Address - Fax:
Practice Address - Street 1:29 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1787
Practice Address - Country:US
Practice Address - Phone:315-265-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012147-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11647121OtherCAQH
NY701418OtherACN GROUP