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General NPI Number Information
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NPI Number | 1790213452
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Entity Type | Organization
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Legal Business Name | FOUR13 THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 24 FRANCES RD
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City | LOS LUNAS
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State | NM
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Zip | 87031-5762
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Country | US
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Telephone | 505-314-6116
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Fax | 505-214-5016
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Provider Business Mailing Address
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Address Line | 24 FRANCES RD
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City | LOS LUNAS
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State | NM
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Zip | 87031-5762
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Country | US
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Telephone |
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Fax | 505-214-5016
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | NICOLE AURAND-ANDES
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Credential |
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Telephone | 505-314-6116
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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 | 3327
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License Number State | NM
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