Healthcare Provider Details

I. General information

NPI: 1558468686
Provider Name (Legal Business Name): KAREN L WELCH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

2990 SENDA DEL PUERTO
SANTA FE NM
87505-6511
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-5739
  • Fax:
Mailing address:
  • Phone: 505-466-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number389
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: