Healthcare Provider Details

I. General information

NPI: 1932023504
Provider Name (Legal Business Name): MELANIE HACKWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE SMITH-SCHEPPLER

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 CERRILLOS RD
SANTA FE NM
87505-1650
US

IV. Provider business mailing address

941 CALLE MEJIA APT 1505
SANTA FE NM
87501-1469
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-6300
  • Fax:
Mailing address:
  • Phone: 561-401-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2026-0125
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: