Healthcare Provider Details

I. General information

NPI: 1134603186
Provider Name (Legal Business Name): JANE VAN BUSKIRK HUELSMANN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 09/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

829 SOLAR RD NW
ALBUQUERQUE NM
87107-5747
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-5550
  • Fax:
Mailing address:
  • Phone: 505-417-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT615
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: