Healthcare Provider Details

I. General information

NPI: 1801284310
Provider Name (Legal Business Name): CAROLYN LAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7513
US

IV. Provider business mailing address

8452 SPAIN RD NE APT. A
ALBUQUERQUE NM
87111-2115
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-5565
  • Fax:
Mailing address:
  • Phone: 520-309-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3010
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: