Provider Demographics
NPI:1699320036
Name:MACMURDO, RYANN (OTR/L OTD)
Entity type:Individual
Prefix:
First Name:RYANN
Middle Name:
Last Name:MACMURDO
Suffix:
Gender:F
Credentials:OTR/L OTD
Other - Prefix:
Other - First Name:RYANN
Other - Middle Name:
Other - Last Name:MACMURDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L OTD
Mailing Address - Street 1:21615 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21615 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6670
Practice Address - Country:US
Practice Address - Phone:310-371-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19807225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics