Healthcare Provider Details

I. General information

NPI: 1265523971
Provider Name (Legal Business Name): SHERRY LEE LOVELACE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1851
US

IV. Provider business mailing address

8204 SARAH CT NW
ALBUQUERQUE NM
87114-1005
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3000
  • Fax:
Mailing address:
  • Phone: 505-268-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number128
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number128
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: