Healthcare Provider Details

I. General information

NPI: 1609967801
Provider Name (Legal Business Name): PATRICIA A WHITESEL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

9101 DEMPSEY DR NE
ALBUQUERQUE NM
87109-6334
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-6414
Mailing address:
  • Phone: 505-463-6452
  • Fax: 505-256-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: