Healthcare Provider Details

I. General information

NPI: 1093314650
Provider Name (Legal Business Name): BEELIGHTFUL THERAPY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6313 BARNHART ST NE
ALBUQUERQUE NM
87109-3510
US

IV. Provider business mailing address

6313 BARNHART ST NE
ALBUQUERQUE NM
87109-3510
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-8031
  • Fax:
Mailing address:
  • Phone: 505-715-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY N APODACA
Title or Position: SOLE OWNER
Credential: MOT
Phone: 505-715-8031