Healthcare Provider Details

I. General information

NPI: 1861526824
Provider Name (Legal Business Name): MICHELLE CAREY MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 MED PARK DR
LAS CRUCES NM
88005-3236
US

IV. Provider business mailing address

301 PERKINS DR STE C
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-7243
  • Fax: 575-525-5641
Mailing address:
  • Phone: 575-523-7243
  • Fax: 575-525-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1654
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2711
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2711
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: