Healthcare Provider Details

I. General information

NPI: 1619427853
Provider Name (Legal Business Name): ARCHELLA SIMONE CLAY MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W MAHONE DR STE A
ARTESIA NM
88210-2075
US

IV. Provider business mailing address

1007 PRINCETON DR
ROSWELL NM
88203-2346
US

V. Phone/Fax

Practice location:
  • Phone: 575-736-3622
  • Fax: 575-736-8536
Mailing address:
  • Phone: 575-317-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2026-0059
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: