Basic Information
| Provider Information | |||||||||
| NPI: | 1134759129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMURTAGH | ||||||||
| FirstName: | DARCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 E FOX DALE CT | ||||||||
| Address2: | |||||||||
| City: | FOX POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532173928 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | W76N677 WAUWATOSA RD | ||||||||
| Address2: | |||||||||
| City: | CEDARBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530121707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623775060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2020 | ||||||||
| LastUpdateDate: | 01/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5592-27 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.