Healthcare Provider Details

I. General information

NPI: 1225808363
Provider Name (Legal Business Name): OWL-CUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 EDITH BLVD NE APT 3
ALBUQUERQUE NM
87102-2535
US

IV. Provider business mailing address

617 EDITH BLVD NE APT 3
ALBUQUERQUE NM
87102-2535
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-9109
  • Fax:
Mailing address:
  • Phone:
  • 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: NICOLE MILLER
Title or Position: OWNER
Credential: MOTR/L
Phone: 505-304-9109