Healthcare Provider Details

I. General information

NPI: 1366433450
Provider Name (Legal Business Name): ELIZABETH A. DILLARD MS, OTR, L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH A. VIGIL MS, OTR, L; LMT

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 OSUNA RD NE
ALBUQUERQUE NM
87109-4430
US

IV. Provider business mailing address

7 WYLIE LN
SANDIA PARK NM
87047-7913
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-0505
  • Fax: 505-312-8414
Mailing address:
  • Phone: 505-508-0505
  • Fax: 505-312-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2024-0084
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT423
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: