Healthcare Provider Details

I. General information

NPI: 1003176660
Provider Name (Legal Business Name): JOHN L CARNAGEY MOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 GOLF COURSE RD SE
RIO RANCHO NM
87124-4971
US

IV. Provider business mailing address

4637 ROCKAWAY LOOP NE
RIO RANCHO NM
87124-6809
US

V. Phone/Fax

Practice location:
  • Phone: 505-578-0867
  • Fax:
Mailing address:
  • Phone: 575-418-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2922
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: