Provider Demographics
NPI:1992124887
Name:MURPHY, JEANETTE S (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:S
Last Name:MURPHY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JEANETTE
Other - Middle Name:M
Other - Last Name:STANIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3014 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4835
Mailing Address - Country:US
Mailing Address - Phone:908-672-1033
Mailing Address - Fax:
Practice Address - Street 1:2830 S REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-5626
Practice Address - Country:US
Practice Address - Phone:385-235-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8360347-4201225XP0019X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation