Healthcare Provider Details

I. General information

NPI: 1710542709
Provider Name (Legal Business Name): EFFIE PULFORD MOTR/L, CNDT, CSRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2019
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 COPPER AVE NE
ALBUQUERQUE NM
87108-1301
US

IV. Provider business mailing address

5006 COPPER AVE NE
ALBUQUERQUE NM
87108-1301
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-7988
  • Fax:
Mailing address:
  • Phone: 505-268-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT3352
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT3352
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: