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General NPI Number Information
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NPI Number | 1912036278
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Entity Type | Individual
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Provider Name | CAROL L MAUPIN-MACIAS OTR
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 1300 COUNTRY CLUB RD SUITE C
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City | SANTA TERESA
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State | NM
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Zip | 88008-9449
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Country | US
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Telephone | 575-589-0303
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Fax | 575-589-4080
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Provider Business Mailing Address
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Address Line | 1300 COUNTRY CLUB RD SUITE C
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City | SANTA TERESA
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State | NM
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Zip | 88008-9449
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Country | US
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Telephone | 575-589-0303
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Fax | 575-589-4080
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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 | 107317
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License Number State | TX
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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 | 2123
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License Number State | NM
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