Healthcare Provider Details

I. General information

NPI: 1710285127
Provider Name (Legal Business Name): DONNA M SPRINGSTEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
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

505 ELM ST NE
ALBUQUERQUE NM
87102-2500
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3603
  • Fax: 505-727-9166
Mailing address:
  • Phone: 505-727-3603
  • Fax: 505-727-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number2087
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: