Healthcare Provider Details

I. General information

NPI: 1669226569
Provider Name (Legal Business Name): CATHERINE DREW RIDENOUR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

IV. Provider business mailing address

6001 IMPERATA ST NE APT 1315
ALBUQUERQUE NM
87111-8019
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2024-0112
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: