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General NPI Number Information
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NPI Number | 1891841540
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Entity Type | Individual
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Provider Name | KENNETH J CORDOVA MOTRL
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 2916 DOROTHY ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1619
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Country | US
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Telephone | 505-244-4175
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Fax | 505-332-3043
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Provider Business Mailing Address
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Address Line | PO BOX 53363
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City | ALBUQUERQUE
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State | NM
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Zip | 87153-3363
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Country | US
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Telephone | 505-730-9540
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Fax | 505-332-3043
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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 | 2214
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License Number State | NM
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