MEDICARE: CYNTHIA W KOENIG OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2294	NM

General Provider Information

NPI Number	:	1093969552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA W KOENIG OT

Provider Business Mailing Address
First Line	:	131 SERENO DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-1533
Country	:	US
Telephone Number	:	505-577-8718
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 9TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4037
Country	:	US
Telephone Number	:	505-426-7466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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