Healthcare Provider Details

I. General information

NPI: 1164850509
Provider Name (Legal Business Name): RENEE BARTLETT CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 CALLE MEJIA
SANTA FE NM
87501-1664
US

IV. Provider business mailing address

183 SUNRISE RD
SANTA FE NM
87507-4253
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number50374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: