Healthcare Provider Details

I. General information

NPI: 1861599722
Provider Name (Legal Business Name): JUDY LORRAINE DARNER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 CONSTITUTION AVE NE SUITE 4
ALBUQUERQUE NM
87110-5900
US

IV. Provider business mailing address

PO BOX 3338
ALBUQUERQUE NM
87190-3338
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1790
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: