=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770077992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET LOUISE POOLE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2018
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 MARBLE NE MSC09 5240
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87131-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-1753
-----------------------------------------------------
Fax | 505-272-3583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 MARBLE NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87131-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-1753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 702
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------