Healthcare Provider Details

I. General information

NPI: 1568227619
Provider Name (Legal Business Name): ANA-ALICIA O'BRIEN MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE O'BRIEN MOT

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4202
US

IV. Provider business mailing address

8415 SONOMA VALLEY RD NE
ALBUQUERQUE NM
87122-2627
US

V. Phone/Fax

Practice location:
  • Phone: 505-855-9804
  • Fax:
Mailing address:
  • Phone: 505-250-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3216
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: