MEDICARE: MRS. AMY RENAE STEWART OTRL

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	1697	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588717342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY RENAE STEWART OTRL

Provider Business Mailing Address
First Line	:	3981 WOOD LOOP
Second Line	:
City	:	ALAMOGORDO
State	:	NM
Zip	:	88310-5495
Country	:	US
Telephone Number	:	575-442-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N FLORIDA AVE
Second Line	:
City	:	ALAMOGORDO
State	:	NM
Zip	:	88310-9713
Country	:	US
Telephone Number	:	575-434-0033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/03/2009

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