Healthcare Provider Details

I. General information

NPI: 1699841478
Provider Name (Legal Business Name): BARBARA ANN HANLON OTLR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 COPPER AVE NE
ALBUQUERQUE NM
87108-1473
US

IV. Provider business mailing address

75 JUNIPER HILL LOOP
CEDAR CREST NM
87008-9430
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-5099
  • Fax:
Mailing address:
  • Phone: 505-286-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1551 OT
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: