Healthcare Provider Details

I. General information

NPI: 1588239644
Provider Name (Legal Business Name): OASIS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 NM-94
MORA NM
87732
US

IV. Provider business mailing address

PO BOX 1051
MORA NM
87732-1051
US

V. Phone/Fax

Practice location:
  • Phone: 505-617-1180
  • Fax:
Mailing address:
  • Phone: 505-617-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DEIDRA CORDOVA
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 505-617-1180