Healthcare Provider Details

I. General information

NPI: 1174387138
Provider Name (Legal Business Name): BUILDING BLOCKS PEDIATRIC THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/02/2025
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 ENTRADA SONATA
SANTA FE NM
87507-2663
US

IV. Provider business mailing address

4215 ENTRADA SONATA
SANTA FE NM
87507-2663
US

V. Phone/Fax

Practice location:
  • Phone: 505-487-3037
  • Fax: 505-216-5294
Mailing address:
  • Phone: 505-487-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BROXTON
Title or Position: VP
Credential: MS OTR/L
Phone: 505-487-3037