Healthcare Provider Details

I. General information

NPI: 1316989015
Provider Name (Legal Business Name): LOUISA A BOYD O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1219
US

IV. Provider business mailing address

4701 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1219
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-4628
  • Fax:
Mailing address:
  • Phone: 505-727-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103124
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2660
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: