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General NPI Number Information
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NPI Number | 1366717696
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Entity Type | Organization
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Legal Business Name | MK THERAPY SERVICES
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 1448 MONTERREY RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-1573
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Country | US
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Telephone | 505-681-0519
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Fax |
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Provider Business Mailing Address
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Address Line | 1448 MONTERREY RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-1573
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Country | US
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Telephone | 505-681-0519
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA JILL MICK
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Credential | OTR/L
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Telephone | 505-681-0519
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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 | 1421
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License Number State | NM
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