Healthcare Provider Details

I. General information

NPI: 1649613167
Provider Name (Legal Business Name): MARY THELANDER HILL MOT R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ELM ST NE
ALBUQUERQUE NM
87102-2500
US

IV. Provider business mailing address

705 CAMINO FLORETTA NW
ALBUQUERQUE NM
87107-5713
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3753
  • Fax:
Mailing address:
  • Phone: 505-244-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: