Healthcare Provider Details

I. General information

NPI: 1841375243
Provider Name (Legal Business Name): THOR RAYMOND SPANGLER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MITCHELL ELEMENTARY 10121 COMANCHE NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

5112 PASTURA PL NW
ALBUQUERQUE NM
87107-3849
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-1937
  • Fax: 505-296-0012
Mailing address:
  • Phone: 505-345-0805
  • Fax: 505-345-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1497
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: