Healthcare Provider Details

I. General information

NPI: 1366855991
Provider Name (Legal Business Name): MERIDIAN COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERIDIAN RAWSKI

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 FAIRBANKS RD NE
ALBUQUERQUE NM
87112-1623
US

IV. Provider business mailing address

4233 ROCK CASTLE LN
SANTA FE NM
87507-8470
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-9889
  • Fax:
Mailing address:
  • Phone: 505-228-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2025-0132
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: