Healthcare Provider Details

I. General information

NPI: 1689341455
Provider Name (Legal Business Name): NURTURE DEVELOPMENT & LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 06/26/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MONTANA AVE STE D
EL PASO TX
79902-5512
US

IV. Provider business mailing address

6112 N MESA ST STE 6108
EL PASO TX
79912-4516
US

V. Phone/Fax

Practice location:
  • Phone: 915-317-6827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACKLYNN A KNOTTS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 915-342-7302