Healthcare Provider Details

I. General information

NPI: 1487724282
Provider Name (Legal Business Name): REBEKAH HINDI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 SHILOH PL NE
ALBUQUERQUE NM
87111-2808
US

IV. Provider business mailing address

4508 SHILOH PL NE
ALBUQUERQUE NM
87111-2808
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-0869
  • Fax: 505-332-8336
Mailing address:
  • Phone: 505-463-0869
  • Fax: 505-332-8336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1494
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: