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General NPI Number Information
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NPI Number | 1417090259
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Entity Type | Individual
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Provider Name | CAROL PHARES OTR
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4216 BALLOON PARK RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-5801
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Country | US
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Telephone | 505-344-5470
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Fax | 505-344-9343
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Provider Business Mailing Address
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Address Line | 2204 RANCHO ORO AVE SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-8729
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Country | US
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Telephone | 505-896-9722
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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 | 811
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License Number State | NM
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