Healthcare Provider Details

I. General information

NPI: 1720701477
Provider Name (Legal Business Name): LYNDSEY RIORDAN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE STE 900
RIO RANCHO NM
87124-6612
US

IV. Provider business mailing address

1316 JACKIE RD SE STE 900
RIO RANCHO NM
87124-6612
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-1042
  • Fax: 505-466-5895
Mailing address:
  • Phone: 505-289-1042
  • Fax: 505-466-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT4666
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: