MEDICARE: SOUTHWEST PEDIATRIC OCCUPATIONAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1467	NM
2	225X00000X	Occupational Therapist	1470	NM

General Provider Information

NPI Number	:	1205268091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PEDIATRIC OCCUPATIONAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	2901A LA HABRA ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-3718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901A LA HABRA ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-3718
Country	:	US
Telephone Number	:	505-325-3039
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. ELIZABETH MURPHY
Credential	:	OTR/L
Telephone Number	:	505-325-3039

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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