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General NPI Number Information
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NPI Number | 1922413376
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Entity Type | Organization
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Legal Business Name | LOW VISION REHABILITATION IN NEW MEXICO LLC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 303 E BUENA VISTA ST APT 5
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City | SANTA FE
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State | NM
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Zip | 87505-2675
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Country | US
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Telephone | 505-259-3672
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E BUENA VISTA ST APT 5
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City | SANTA FE
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State | NM
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Zip | 87505-2675
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Country | US
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Telephone | 505-259-3672
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | COBY L LIVINGSTONE
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Credential |
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Telephone | 505-259-3672
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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 | 3146
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License Number State | NM
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