Healthcare Provider Details

I. General information

NPI: 1164663696
Provider Name (Legal Business Name): FRANCES EHRENBERG-HYMAN MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W SAND SAGE
SANTA FE NM
87506-7784
US

IV. Provider business mailing address

18 W SAND SAGE
SANTA FE NM
87506-7784
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-5810
  • Fax: 505-424-9331
Mailing address:
  • Phone: 505-474-5810
  • Fax: 505-424-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1894
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: