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General NPI Number Information
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NPI Number | 1407489040
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Entity Type | Individual
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Provider Name | MICHELLE RANDALL MOTR-L
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 980 BOSQUE FARMS BLVD
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City | BOSQUE FARMS
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State | NM
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Zip | 87068-9652
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Country | US
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Telephone | 505-554-0052
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 STEVENS DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1449
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Country | US
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Telephone | 505-321-8217
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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