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General NPI Number Information
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NPI Number | 1154976181
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Entity Type | Individual
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Provider Name | ANNA WILDER MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 1800 OLD PECOS TRL
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City | SANTA FE
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State | NM
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Zip | 87505-4759
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Country | US
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Telephone | 505-424-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 1262 SENDA DEL VALLE
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City | SANTA FE
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State | NM
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Zip | 87507-7178
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Country | US
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Telephone | 505-920-7966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4130
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License Number State | NM
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