Healthcare Provider Details

I. General information

NPI: 1942806880
Provider Name (Legal Business Name): HIGH DESERT OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 TRAMWAY CIR NE
ALBUQUERQUE NM
87122-2239
US

IV. Provider business mailing address

2818 TRAMWAY CIR NE
ALBUQUERQUE NM
87122-2239
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-1125
  • Fax:
Mailing address:
  • Phone: 505-573-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIN DREW COOK
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 505-573-1125