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General NPI Number Information
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NPI Number | 1861804049
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Entity Type | Individual
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Provider Name | DENILLE MARIE STOREY MOT R/L
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Gender | Female
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 10501 GOLF COURSE RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5019
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Country | US
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Telephone | 505-727-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 912 S CAPITAL OF TEXAS HWY SUITE 225
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5264
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Country | US
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Telephone |
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 3204
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License Number State | NM
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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 | OT16271
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License Number State | CA
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