Healthcare Provider Details

I. General information

NPI: 1871706853
Provider Name (Legal Business Name): M. CELESTE MCCONNELL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/17/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1961
US

IV. Provider business mailing address

628 CAMBECK DR SE UNIT 2
LELAND NC
28451-1489
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-2111
  • Fax:
Mailing address:
  • Phone: 910-274-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5666
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT4407
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: