Provider Demographics
NPI:1740481803
Name:MURPHY, JAIME MICHELE (OTR)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:MICHELE
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 1:215 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3542
Mailing Address - Country:US
Mailing Address - Phone:631-730-8719
Mailing Address - Fax:
Practice Address - Street 1:78 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1219
Practice Address - Country:US
Practice Address - Phone:631-288-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012878-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist