Healthcare Provider Details

I. General information

NPI: 1679118707
Provider Name (Legal Business Name): TAL THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S SAINT FRANCIS DR
SANTA FE NM
87501-2445
US

IV. Provider business mailing address

238 AMBROSIO ST APT 1
SANTA FE NM
87501-2868
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5836
  • Fax: 505-982-0732
Mailing address:
  • Phone: 575-770-5836
  • Fax: 505-982-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESA ANN LIFVERGREN
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential: OTL/R
Phone: 575-770-5360