MEDICARE: PATHWAYS

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	235Z00000X	Speech-Language Pathologist
2	225XP0200X	Pediatric Occupational Therapist	2311	NM
3	225X00000X	Occupational Therapist	2311	NM

General Provider Information

NPI Number	:	1205953890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS

Provider Business Mailing Address
First Line	:	5138 CASTLE ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-8949
Country	:	US
Telephone Number	:	505-426-7466
Fax Number	:	505-425-7196

Provider Business Practice Location Address
First Line	:	1118 9TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4037
Country	:	US
Telephone Number	:	505-429-0805
Fax Number	:	505-425-7196

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RAYCHEL A HOSCH
Credential	:	CCCSLP
Telephone Number	:	505-426-7466

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/05/2008

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Directions to “PATHWAYS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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