Healthcare Provider Details

I. General information

NPI: 1437204807
Provider Name (Legal Business Name): NANCY R MULLER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 MILNE RD NW CHAPARRAL ES
ALBUQUERQUE NM
87120-1691
US

IV. Provider business mailing address

6325 MILNE RD NW CHAPARRAL ES
ALBUQUERQUE NM
87120-1691
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-3301
  • Fax:
Mailing address:
  • Phone: 505-831-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1443
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: