=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669533972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TURQUOISE TRAIL ELEMENTARY SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13A SAN MARCOS LOOP
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87508-8627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-467-1700
-----------------------------------------------------
Fax | 505-474-7862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13A SAN MARCOS LOOP
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87508-8627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-467-1700
-----------------------------------------------------
Fax | 505-474-7862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | RANDY FREEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-467-1770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | M-04897
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2380
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 3343
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 071155
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 1975
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------