Provider Demographics
NPI:1073018776
Name:MURILLO, ERWIN
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:MURILLO
Suffix:
Gender:M
Credentials:
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 3667
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3667
Mailing Address - Country:US
Mailing Address - Phone:662-680-3148
Mailing Address - Fax:662-620-9890
Practice Address - Street 1:2400 E MITCHELL ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3036
Practice Address - Country:US
Practice Address - Phone:662-680-3148
Practice Address - Fax:662-620-9890
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist